机械性血栓清除装置在治疗急性下腔静脉滤过器相关性血栓中的应用  

The Utilization of Angio Jet Thrombectomy in Patients with Acute Inferior Vena Cava Filter-Related Thrombosis

作　　者：宋进华[1] 施万印[1] 赵伯翔[1] 何旭[1] 楼文胜[1] 陈亮[1] 顾建平[1] SONG Jinhua;SHI Wanying;ZHAO Boxiang(Department of Interventional Radiology,Nanjing First Hospital Affiliated to Nanjing Medical University,Nanjing 210006,P.R.China)

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

出　　处：《临床放射学杂志》2018年第7期1190-1195,共6页Journal of Clinical Radiology

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

摘　　要：目的探讨Angio Jet机械性血栓清除装置在急性下腔静脉滤过器相关性血栓治疗中的临床价值。方法12例下腔静脉滤过器植入术后患者,术前CTA明确诊断,滤过器植入时间5~400天,所有病例均行股静脉穿刺入路,置入Angio Jet血栓清除装置,通过喷射模式进行血栓内喷射,等待15 min后行血栓抽吸治疗。术后均保留溶栓导管进行持续溶栓治疗1~3天,尿激酶用量50万U/天,每天造影如果血栓完全溶解则取出下腔静脉滤器并终止溶栓治疗。术后随访6个月,1个月、6个月时行下腔静脉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;血栓清除率50%~90%为Ⅱ级;血栓清除率〈50%为Ⅰ级。结果所有患者下腔静脉血栓均进行了机械性血栓抽吸治疗,术后造影评估5例下腔静脉血栓清除Ⅲ级,6例Ⅱ级,1例Ⅰ级。经过1~3天溶栓治疗,尿激酶用量为（125±43）万U,11例下腔静脉血栓清除Ⅲ级,1例下腔静脉血栓清除Ⅱ级。术后6个月随访无血栓复发患者。无手术相关的严重并发症和死亡发生。结论 Angio Jet机械性血栓清除装置结合小剂量溶栓治疗急性下腔静脉滤过器相关性血栓安全、有效。Objective The purpose of this study is to evaluate the clinical value of percutaneous Angio Jet thrombectomy in treatment of acute inferior vena cava filter-related thrombosis. Methods A total of 12 patients with acute inferior vena cava filter-related thrombosis were verified by computed tomographic angiography（ CTA） were included in this study. Infe- rior vena cava filters had been implanted in all patients from 5 to 400 days before diagnosis. Percutaneous AngioJ et 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. After the thrombectomy procedure,all patients received continuous transcatheter infusion of urokinase（ 500,000 U/d） for 1 to 3 days until the thrombosis was completely dissolved confirmed by angiography at24,48 and 72 hours. Inferior vena cava filters were retrieved from 11 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 were used in evaluation of thrombolysis： grade Ⅰ =〈 50% thrombus removal; grade Ⅱ = 50%-90% thrombus removal,and grade Ⅲ = 〉90%thrombus removal. Results All 12 patients were treated by AngioJ et thrombectomy device for acute inferior vena cava filter-related thrombosis. Angiography after the thrombectomy procedure showed complete thrombus removal（ 〉90%） was in5 cases,substantial thrombus removal（ 50%-90%） in 6 cases,and partial thrombus removal（ 〈50%） in the remaining1 case. The average dosage of the urokinase used for thrombolytic therapy post thrombectomy was 1,250,000 ± 430,000 units. Grade Ⅲ（ complete） thrombolysis was achieved in 11 cases and grade Ⅱ in 1 case. Venous patency was comfirmed in all 12 patients at 6 month after the treatment. There were no major complications or patient death related to

关 键 词：滤器相关血栓 经皮机械性血栓清除 放射学 介入性 

分 类 号：R543.6[医药卫生—心血管疾病] R816.2[医药卫生—内科学]