支架植入治疗滤器源性慢性下腔静脉闭塞价值分析  

Stent placement for filter-related chronic occlusion of the inferior vena cava

作　　者：赵伯翔[1] 何旭[1] 顾建平[1] 楼文胜[1] 陈亮[1] 公茂峰 Zhao Boxiang;He Xu;Gu Jianping;Lou Wensheng;Chen Liang;Gong Maofeng(Department of Vascular and Interventional Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,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)介入血管科,南京210006

出　　处：《中华医学杂志》2019年第43期3403-3407,共5页National Medical Journal of China

基　　金：国家自然科学基金(81871463)。

摘　　要：目的评估支架植入治疗滤器源性慢性下腔静脉闭塞的技术成功率、支架通畅率、临床有效率及并发症发生率.方法收集2016年3月至2018年12月在南京市第一医院行支架植入治疗的12例合并严重血栓后综合征且保守治疗无缓解的滤器源性慢性下腔静脉闭塞患者的临床资料,其中男9例、女3例,年龄48~77岁,平均年龄60岁.12例患者中有6例以双侧下肢症状为主,6例以单侧下肢症状为主.对支架植入治疗的技术成功率、支架通畅率、临床有效率及并发症发生率进行统计分析.临床有效定义为术后治疗侧肢体症状改善,临床表现、病因、解剖和病理生理学(CEAP)分级术后较术前至少降低1级.结果11例患者成功进行支架植入,完全开通下腔静脉闭塞段及目标侧单侧髂静脉或双侧髂静脉闭塞段,1例因导丝无法通过左髂静脉闭塞段,行下腔静脉及右髂静脉闭塞段支架植入.下腔静脉及单侧髂静脉支架植入7例,下腔静脉及双侧髂静脉支架植入5例.1例患者术后出现急性支架内血栓闭塞,经导管接触性溶栓及再次支架植入后血流复通.术后随访6~24个月,平均(13±6)个月,随访期间所有患者下肢CTV或静脉造影均显示支架内血流通畅.12例患者在末次随访时均评估为临床有效.3例患者在术中出现短暂治疗侧腰部酸痛,均可自行缓解;所有患者在围手术期及随访过程中均未出现与治疗相关的明显腹痛、严重出血及症状性肺栓塞等并发症.结论支架植入治疗滤器源性慢性下腔静脉闭塞安全可行,能够缓解严重血栓后综合征患者的临床症状.Objective To assess the technical success rate,stent patency,clinical efficacy and complications of stent placement for filter-related chronic occlusion of the inferior vena cava.Methods A retrospective analysis was carried out for 12 patients with filter-related chronic occlusion of the inferior vena cava associated with severe post-thrombotic syndrome,who underwent stent placement after ineffective conservative therapy at Nanjing First Hospital from March 2016 to December 2018,9 males and 3 females,aged from 48 to 77 years,mean age 60 years,six had bilateral lower extremity symptoms and six had unilateral lower extremity symptoms.Technical success rate,stent patency,clinical efficacy and complications of stent placement were recorded.Clinical success was defined as relief of symptoms and a decrease in clinical,etiology,anatomy,and pathophysiology(CEAP)score for at least grade 1.Results Stent placement in the unilateral or bilateral iliocaval occlusion was successful in 11 patients.The cause of technical failure in the single patient with failed stent placement was an inability to cross the occluded left iliacvein and the patient was treated with stent placement in the right iliocaval vein.There were 7 patients with inferior vena cava and unilateral iliocaval stent placement;5 patients with inferior vena cava and bilateral iliocaval stent placement.Acute stent thrombosis occlusion occurred in 1 case after the operation,the blood flow recanalized after catheter-directed thrombolysis and re-stenting.All patients were followed up for 6 to 24 months,with an average of(13±6)months.During the follow-up period,CTV or venography of lower limbs showed that the blood flow in the stent was unobstructed.At the last follow-up,12 patients were evaluated as clinically effective.Three patients had transient treatment of lateral lumbar pain during operation,which alleviated by themselves.No significant abdominal pain,severe hemorrhage,symptomatic pulmonary embolism and other complications related to treatment occurred in all pa

关 键 词：腔静脉滤器 腔静脉 下 血栓形成后综合征 支架 

分 类 号：R47[医药卫生—护理学]