急性髂股静脉血栓治疗中AngioJet机械性血栓清除装置初步应用结果  

Preliminary results of application of percutaneous AngioJet thrombectomy in patients with acute iliofemoral deep venous thrombosis

作　　者：宋进华[1] 何旭[1] 楼文胜[1] 陈亮[1] 陈国平[1] 苏浩波[1] 施万印[1] 赵伯翔[1] 邵泽锋[1] 顾建平[1] 

机构地区：[1]南京医科大学附属南京医院南京市第一医院介入科,210006

出　　处：《中华放射学杂志》2015年第10期758-762,共5页Chinese Journal of Radiology

基　　金：江苏省临床医学科技专项（BL2014013）;南京市医学科技发展项目（YKK14087）

摘　　要：目的探讨AngioJet机械性血栓清除装置在急性髂股静脉血栓治疗中的临床价值。方法经血管超声、下肢静脉CTA明确诊断的15例下肢深静脉血栓患者，术前置入下腔静脉滤过器。除1例脑出血患者，均在术中使用尿激酶25万u（溶入100ml生理盐水），通过AngioJet机械性血栓清除装置喷射模式进行血栓内喷射，等待15min后行机械性血栓抽吸治疗。除外溶栓绝对禁忌证的患者，术后均保留溶栓导管进行持续溶栓治疗1—3d，尿激酶用量25万～50万U／d。每天血管造影检查，如果血栓完全溶解并显示髂静脉受压综合征，则植入髂静脉支架，取出下腔静脉滤器并终止溶栓治疗。术后随访6个月，1、6个月时行下肢静脉CTA复查，术后口服抗凝治疗至少6个月。血栓清除评判标准：血栓清除率〉90％为Ⅲ级、50％～90％为Ⅱ级、〈50％为I级。结果所有患者下肢髂股静脉血栓均进行了机械性血栓抽吸治疗，术后造影评估9支下肢髂股静脉血栓清除Ⅲ级、6支Ⅱ级、2支I级。经过1～3d溶栓治疗，12支下肢髂股静脉血栓清除Ⅲ级、5支清除Ⅱ级。其中7例发现左侧髂静脉受压综合征，予球囊扩张及支架植入治疗；12例溶栓结束后取出下腔静脉滤器。15例术后1个月、8例术后6个月CTA复查血栓无复发，无手术相关的严重并发症和死亡发生。结论AngioJet机械性血栓清除装置结合溶栓治疗急性髂股静脉血栓安全、有效。Objective To evaluate the percutaneous AngioJet thrombectomy in the treatment of acute iliofemoral deep venous thrombosis （DVT） . Methods A total of 15 patients with lower extremity DVT verified by color Doppler ultrasound and computed tomographic angiography （CTA） were included in the study. Inferior vena cava filter was implanted in all patients prior to the thrombectomy. Percutaneous AngioJet thrombectomy was performed after a mixture of 250 000 U of urokinase in 100 ml of normal saline for local thrombolysis in all patients for approximately 15 minutes, except for 1 patient with cerebral hemorrhage. After the thrombectomy procedure, all patients received continuous transcatheter infusion of urokinase （250 000 to 500 000 U/d） for 1 to 3 days until the thrombosis was confirmed to be completely dissolved by angiography at 24, 48 and 72 hours. Those patients with May-Thurner syndrome underwent PTA and stent implantation. Inferior vena cava filter was retrieved from the patients post procedure and the thrombolytic therapy was discontinued. The patency rate of iliofemoral venous was assessed by CTA at 1 and 6 months after the procedure. Patients were discharged with oral anticoagulation regimen for at least 6 months. The following criteria are used in the evaluation of thrombolysis： grade I 〈50% thrombus removal; grade Ⅱ =50% to 90% thrombus removal, and grade Ⅲ ≥90% thrombus removal. Results All 15 patients were treated by AngioJet thrombectomy device for iliofemoral DVT. Angiography after the thrombectomy procedure showed complete thrombus removal （〉90%） in 9 limbs, substantial thrombus removal （50% to 90%） in 6 limbs, and partial thrombus removal （〈50%） in the remaining 2 limbs. The average dosage of the urokinase used for thrombolytic therapy post thrombectomy was 1 030 000 U （500 000 to 2 750 000 U）. GradeⅢ （complete） thrombolysis was achieved in 12 limbs and grade Ⅱ （50% to 90%） thrombolysis in 5 of limbs. A total of 7 patients who had May-Thurner syndrome

关 键 词：静脉血栓形成 放射学 介入性 血栓溶解疗法 

分 类 号：R654.4[医药卫生—外科学]