髂静脉受压综合征并发急性节段性髂股静脉血栓的血管腔内治疗  

Single-session endovascular treatments for iliac vein compression syndrome with secondary acute segmental iliofemoral deep vein thrombosis

作　　者：朱桥华[1] 周成宇[1] 陈勇[2] 赵剑波[2] 黄维[1] 罗美华[1] 莫海鹰[1] 于新发[1] 

机构地区：[1]医科大学附属顺德第一人民医院肿瘤介入科,南方 528300 [2] 南方医科大学附属南方医院介入治疗科

出　　处：《中华放射学杂志》2014年第10期848-852,共5页Chinese Journal of Radiology

基　　金：广东省科技计划项目（20098030801210）

摘　　要：目的 探讨以经皮人工抽吸血栓清除术（MAT）作为主要的血栓清除方法,在MAT后立即行球囊扩张及支架置入术的一次性介入方案,治疗髂静脉受压综合征（IVCS）并发急性节段性髂股深静脉血栓形成（DVT）的可行性、疗效及安全性.方法 前瞻性纳入IVCS并发急性节段性髂股DVT患者26例[女17例、男9例;年龄33～ 79岁,平均（55±13）岁].所有患者均表现为左下肢肿胀或疼痛.IVCS的确诊依靠CT血管成像.所有患者在确诊后即给予抗凝治疗,介入术后至少维持6个月.经患肢腘静脉入路行血管腔内治疗,MAT、球囊扩张及支架置入术在一次手术过程内完成.MAT后残留少许血栓者行经导管溶栓治疗（尿激酶80万单位维持12h）.对患者的治疗情况进行随访.结果 所有患者均成功施行一次性血管腔内治疗.手术时间45～ 90 min,平均（67±13）min.所有患者在MAT后血栓均达到完全清除,接近100％者24例,残留＜5％者2例,残留血栓经溶栓后完全溶解.MAT后静脉造影显示左髂静脉狭窄者24例,闭塞者2例.所有患者均成功开通左髂总静脉,共置入支架26枚,支架直径10～ 14 mm,长度60 ～ 100 mm.患肢症状完全缓解者25例,部分缓解者1例.住院时间2.0～4.0d,平均（2.7±0.3）d.随访时间12～ 25个月,平均（18±4）个月.1例在术后11个月出现支架内血栓形成,经溶栓后复通.1年初次通畅率和二次通畅率分别为96％（25/26）和100％（26/26）.除5例患者在球囊扩张中出现一过性腰痛外,未见其他并发症.结论 以MAT作为主要血栓清除方法、在MAT后立即行球囊扩张及支架置入术的一次性介入方案治疗IVCS并发急性节段性髂股DVT是可行的,近期疗效确切、安全。Objective To evaluate the feasibility,safety and effectiveness of single-session endovascular treatment with manual aspiration thrombectomy （MAT） as first-line thrombus removal method for iliac vein compression syndrome （IVCS） with secondary acute segmental iliofemoral deep vein thrombosis （DVT）.Methods Twenty-six patients [19 women,7 men,and mean age （55±13） years] with left-sided acute iliac-common femoral DVT secondary to IVCS were enrolled in this prospective clinical study.All patients presented with leg swelling or pains.The duration of symptoms ranged from 1 to 11 days （mean time 5.2 days）.IVCS were diagnosed by CT venography.Anticoagulation therapy was given to all patients upon diagnosed and maintained for minimum 6 months after interventions.Endovascular treatment,consisted of MAT,balloon angioplasty and stent placement,was performed via ipsilateral popliteal vein and completed in the same setting.Overnight antegrade thrombolysis （urokinase 800 000 units lasting for 12 h） was performed in patients with residual thrombus after MAT.Patients were followed up on long-term.Results Single-session endovascular procedures were performed successfully in all patients.The mean procedure time was （67± 13） min （ranging from 45 to 90 min）.Complete thrombus removal,including almost 100% of removal in 24 patients and little residual thrombus （〈5%） in 2,was achieved after repeated MAT.Thrombolysis was used in these 2 patients.Complete symptomatic relief was achieved in 25 patients （96%） and partial relief in one.The hospital stay ranged from 2 to 4 days [mean （2.7 ±0.3） days].Recurrent thrombosis within the stent was observed in one case and recanalized with thrombolysis.The 1-year primary and secondary patency rate was 96%（25/26） and 100%（26/26）,respectively.No symptomatic pulmonary embolization,bleeding and venous reflux were observed.Five patients complained about transitory low back pains during balloon angioplasty.The mean follow-up period was 18 months （12

关 键 词：髂静脉 静脉血栓形成 放射学 介入性 

分 类 号：R654.3[医药卫生—外科学]