经皮机械性血栓清除术同期联合髂静脉支架置入治疗髂静脉压迫综合征并发急性下肢深静脉血栓形成  

Percutaneous Mechanical Thrombectomy Combined with Iliac Vein Stent Implantation in theTreatment of Iliac Vein Compression Syndrome Complicated with Acute Lower Extremity Deep VenousThrombosis

作　　者：赵辉[1] 胡红耀[1] 饶珉[1] 吴振中[1] 任权 吴晶晶[1] 王英 冯军伟 李忠 刘健伟 ZHAO Hui;HU Hongyao;RAO Min(Department of Interventional Radiology,Renmin Hospital of Wuhan University,Wuhan,Hubei Province 430060,P.R.China)

机构地区：[1]武汉大学人民医院放射介入科,430060

出　　处：《临床放射学杂志》2021年第4期806-810,共5页Journal of Clinical Radiology

基　　金：湖北省自然科学基金资助项目(编号:2016CFB695)。

摘　　要：目的探讨经皮机械性血栓清除术(PMT)同期联合髂静脉支架置入治疗髂静脉压迫综合征(IVCS)并发急性下肢深静脉血栓形成(DVT)的可行性、安全性及有效性。方法对15例IVCS并发急性DVT患者,应用Aspirex装置PMT治疗DVT,同期球囊扩张和髂静脉支架置入治疗IVCS,有残留血栓的患者经导管进行辅助的溶栓治疗。患者治疗前均置入下腔静脉滤器,治疗后取出。观察治疗前后不良反应、并发症及症状改善情况。术后1、3、6、12个月随访评估深静脉及支架内血流情况。结果患者均成功同期完成手术,手术时间55~100 min,平均(79.7±13.6)min。6例患者血栓清除Ⅲ级(完全清除);其余9例为血栓清除Ⅱ级(部分清除),置管溶栓1~3天后清除残留血栓。患者治疗后临床症状均缓解,无肺栓塞、急性肾功能衰竭、严重出血等并发症。随访期间,1例患者术后1个月时外伤引起脑出血停止抗凝治疗后血栓复发;其余14例术后随访均无血栓复发,髂静脉支架均通畅。结论 PMT同期联合髂静脉支架置入治疗IVCS并发急性DVT安全可行,初步临床疗效满意。Objective To investigate the feasibility, safety and effectiveness of percutaneous mechanical thrombectomy(PMT) combined with iliac vein stent implantation in the treatment of iliac vein compression syndrome(IVCS) complicated with acute lower extremity deep venous thrombosis(DVT). Methods Fifteen patients with acute DVT and IVCS underwent interventional treatment.Aspirex thrombectomy, balloon angioplasty and iliac vein stent implantation were successively performed in the same procedure and patients with residual thrombus were treated by catheter directed thrombolysis.Inferior vena cava filter was placed in all patients before treatment and retrieved after treatment.The adverse reactions and complications of interventional treatment and the improvement of symptoms after treatment were observed.The patients were followed up to assess the blood flow in deep veins and stents at 1,3,6,and 12 months after the procedure. Results All patients were successfully treated with the combination of several therapies in a single procedure and the operation time for the procedure was 55-100 minutes, with a mean of(79.7±13.6) minutes.Thrombus clearance rate of grade III(complete removal) was observed in 6 patients. Grade II(partial removal) was noted in the remaining 9 patients and the residual thrombus was then cleared after 1 to 3 days of catheter directed thrombolysis. Aftertreatment the clinical symptoms were alleviated in all patients and postoperative complications such as pulmonary embolism, acute renal failure and severe hemorrhage were not observed.During the follow-up period, DVT recurred in one patient 1 month after the procedure, who suffered from cerebral hemorrhage and stopped anticoagulation therapy.The remaining 14 patients had no recurrence of thrombosis and the iliac vein stents remained patent. Conclusion PMT combined with iliac vein stent implantation may be a safe and feasible strategy for treating IVCS complicated with acute DVT,with satisfactory preliminary clinical results.

关 键 词：髂静脉压迫综合征 深静脉血栓形成 经皮机械性血栓抽吸术 支架置入 

分 类 号：R654.4[医药卫生—外科学]