药物-机械导管溶栓联合Venovo静脉支架植入治疗髂静脉压迫伴急性下肢深静脉血栓形成  

Pharmacomechanical catheter-directed thrombolysis combined with Venovo venous stent implantation in treating iliac vein compression syndrome complicated by acute lower extremity deep venous thrombosis

作　　者：吕正佐 王兵[1] 牛晓阳[1] 王岭 郑浩哲 LV Zhengzuo;WANG Bing;NIU Xiaoyang;WANG Ling;ZHENG Haozhe(Department of Vascular Surgery,Fifth Afiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052,China)

机构地区：[1]郑州大学第五附属医院血管外科,河南郑州450052

出　　处：《介入放射学杂志》2024年第6期627-632,共6页Journal of Interventional Radiology

摘　　要：目的评价药物-机械导管溶栓(pharmacomechanical catheter-directed thrombolysis,PCDT联合Venovo(Bard)静脉支架植入治疗髂静脉压迫综合征(iliac vein compression syndrome,IVCS)伴急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的短期疗效及安全性。方法回顾性分析2022年7月至2022年12月于郑州大学第五附属医院采用PCDT联合Venovo静脉支架植入治疗IVCS伴急性下肢DVT的23例患者临床资料,评价患者手术前后下肢周径差及术后血栓清除率。于术后第1、3、6个月进行门诊随访,记录患者静脉临床严重程度评分(venous clinical severity score,VCSS)并检查支架通畅情况。结果所有手术均获成功,靶病变血栓均达到完全清除(清除率>95%),同期植入Venovo髂静脉支架23枚。术后6个月随访期间未见支架发生移位、断裂或脱落等情况,无死亡病例。23例患者下肢患-健侧周径差(大腿、小腿)分别由术前(5.59±0.93)cm、(3.52±0.85)cm下降为术后(1.43±0.68)cm、(1.41±0.72)cm,差异具有统计学意义(均P<0.05)。术后第6个月时VCSS较术前显著降低(5.4±1.1 vs 8.0±1.9,P<0.05),差异具有统计学意义。术后第6个月时一期通畅率为95.7%(22/23),手术再干预率为4.3%。结论应用PCDT联合Venovo静脉支架植入治疗IVCS伴急性下肢DVT安全有效,具有较好的临床应用前景。Objective To investigate the short-term efficacy and clinical safety of pharmacomechanical catheter-directed thrombolysis(PCDT)combined with Venovo(Bard)venous stent implantation in treating iliac vein compression syndrome(IVCS)associated with acute lower extremity deep venous thrombosis(DVT).Methods The clinical data of 23 IVCS patients with acute DVT,who received PCDT combined with Venovo venous stent implantation at the Fifth Affiliated Hospital of Zhengzhou University of China between July 2022and December 2022,were retrospective analyzed.The differences in preoperative and postoperative lower limb circumference and the postoperative thrombus clearance rate were evaluated.Outpatient follow-up was conducted at one,3,and 6 months after treatment,and the patient's venous clinical severity score(VCSS)was recorded and the stent patency was checked.Results Successful surgery was achieved in all 23patients,and the target lesion thrombus was completely cleared(clearance ratio>95%).A total 23 Venovo iliac vein stents were implanted during the same period.During the follow-up period of 6 months,neither displacement,fracture or detachment of the stent nor death occurred.In the 23 patients,the circumference differences of thigh and calve between the affected and healthy lower limbs decreased from preoperative(5.59±0.93)cm and(3.52±0.85)cm respectively to postoperative(1.43±0.68)cm and(1.41±0.72)cm respectively,the differences were statistically significant(both P<0.05).Six months after treatment,the VCSS significantly decreased from preoperative(8.0±1.9)points to postoperative(5.4±1.1)points,the difference was statistically significant(P<0.05),the primary patency rate was 95.7%(22/23),and the surgical re-intervention rate was 4.3%.Conclusion For the treatment of IVCS complicated by acute lower extremity DVT,combination use of PCDT and Venovo venous stenting is clinically safe and effective,therefore,this technique carries good prospect of clinical application.

关 键 词：髂静脉压迫综合征 深静脉血栓形成 药物机械导管溶栓 静脉支架置入术 疗效分析 

分 类 号：R654.2[医药卫生—外科学]