经皮机械性血栓清除术治疗急性髂股静脉血栓  

Percutaneous mechanical thrombectomy for treatment of acute iliofemoral vein thrombi

作　　者：赵辉[1] 胡红耀[1] 饶珉[1] 吴振中[1] 任权 吴晶晶[1] 李忠 ZHAO Hui;HU Hongyao;RAO Min;WU Zhenzhong;REN Quan;WU Jingjing;LI Zhong(Department of Interventional Radiology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院放射介入科,湖北武汉430060

出　　处：《中国介入影像与治疗学》2020年第7期393-397,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：湖北省自然科学基金(2016CFB695)。

摘　　要：目的观察经皮机械性血栓清除术(PMT)治疗急性髂股静脉血栓的有效性和安全性。方法对21例急性髂股静脉血栓形成患者置入下腔静脉滤器,之后应用Aspirex导管行PMT,并造影评估血栓清除效果,发现血栓残留时行经导管接触性溶栓治疗;如清除血栓发现髂静脉严重狭窄或闭塞,则行球囊扩张及支架植入术。最后取出下腔静脉滤器。观察治疗并发症、血栓清除效果及症状改善情况。术后1、3、6个月随访评估静脉通畅情况,并以Villalta评分判断血栓后综合征发生与否及其等级。结果 21例均顺利完成PMT。8例血栓完全清除;13例血栓部分清除,经置管溶栓后残留血栓均获清除。13例因左髂静脉重度狭窄或闭塞而接受球囊扩张及支架植入术。治疗后21例静脉血流均恢复,下肢肿胀、疼痛症状均缓解,无手术相关严重并发症及死亡。术后随访未见血栓复发,髂静脉支架均通畅;1例术后6个月Villalta评分5分,为轻度血栓后综合征。结论 PMT治疗急性髂股静脉血栓安全有效。Objective To observe the efficacy and safety of percutaneous mechanical thrombectomy(PMT)in treatment of acute iliofemoral vein thrombi.Methods PMT using Aspirex catheter was performed in 21 patients of acute iliofemoral vein thrombi after placement of inferior vena cava filter.Angiography was performed to evaluate thrombi clearance after PMT.Patients with residual thrombi were treated with adjunctive catheter directed thrombolysis(CDT)and reexamined with angiography every day.After thrombi removal,balloon dilatation and stent implantation were performed if severe stenosis or occlusion of iliac vein was found.Then inferior vena cava filter was retrieved.The complications of interventional therapy,the effect of thrombi removal and the improvement of symptoms were observed.The patency of deep vein and the Villalta scoring system were evaluated for assessment of the incidence of post-thrombotic syndrome 1,3 and 6 months after the procedures.Results All 21 patients were successfully treated with PMT.Eight patients had gradeⅢthrombectomy(complete removal).The other 13 patients had gradeⅡthrombectomy(partial removal),and the residual thrombi were cleared with CDT.Balloon dilation and stent placement were performed in 13 patients with severe stenosis or occlusion of left iliac vein.The venous blood flow restored and symptoms of lower limb swelling and pain alleviated in all 21 patients after therapy.There was no death nor serious complication related to the procedures.No thrombosis recurrence was found,and all stents kept patent during the follow-up.One patient with 5 points of Villalta score developed mild post thrombotic syndrome 6 months after procedure.Conclusion PMT is effective and safe for treatment of acute iliofemoral vein thrombi.

关 键 词：髂静脉 股静脉 静脉血栓形成 血管内治疗 机械取栓 

分 类 号：R658.3[医药卫生—外科学] R815[医药卫生—临床医学]