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多静脉入路腔内微创治疗下肢深静脉血栓及血栓后综合征单中心研究
Multi-approach Endovenous Techniques in the Treatment of Iliofemoral Deep Venous Thrombosis and Post-thrombotic Syndrome
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DOI:
作者:
柏骏, 曲乐丰, 职康康, 高志伟, 吴永发, 王亮, 金杰
Jun Bai,Lefeng Qu,kangkang Zhi,Zhiwei Gao,Yongfa Wu,Liang Wang,Jie Jing
作者单位:
上海长征医院
changzheng hospital , Second Military Medical University , shanghai 200003 , china .
关键词:
多静脉入路血管腔内技术;下肢深静脉血栓形成;血栓形成后综合征
Multi-approach Endovascular Technique; Iliofemoral Deep Venous Thrombosis; Post-thrombotic Syndromer
摘要:
目的 评价多种静脉入路的血管腔内技术在下肢深静脉血栓(DVT)及血栓后遗综合征(PTS)治疗中的应用价值。方法 回顾性分析2012年4月到2013年5月我科收治的54例DVT患者,所有病例经多普勒血管超声及(或)数字减影血管造影确诊。根据下肢深静脉顺行静脉造影情况,选择性使用四种静脉入路行下肢深静脉置管溶栓术及球囊扩张、支架成形术:①经股静脉入路、②经腘静脉入路、③经大隐静脉入路、④经小隐静脉入路。所有的病人都进行3-15个月个月的随访。随访内容包括患者体检、凝血功能检测、国际标准化比值(INR),患肢彩色多普勒超声及或静脉造影。结果 技术成功率为98%(53/54)。其入路选择是经股静脉(12/54)、经腘静脉(27/54)、经大隐静脉(9/54)、经小隐静脉(6/54)。在接受CDT的39例DVT患者,完全再通的病例数为15(38%),部分再通的为24例(62%)。19例伴残余狭窄DVT患者和14例PTS患者接受了球囊扩张,在33个病例中放置了自膨式支架33枚。围手术期无死亡和症状性肺动脉栓塞(PE)。5例患者出现穿刺处或牙龈少量渗血。1例出现腹股沟穿刺点血肿。对53例成功病例平均8.2+1.4月随访(3-15个月)。无死亡及致死性PE发生,51例患者通畅良好,1例患者术后2周再次形成血栓。1例一年后出现支架远端狭窄。结论 结果显示,多种静脉入路为DVT和PTS微创治疗提供了丰富的入路选择,可根据病情的不同合理选择入路方法。每个方法都有利弊,但结合使用有利于提高治疗的成功率。腘静脉入路更为常用且操作方便。
Objective To evaluate the value of multi-approach endovascular techniques in the treatment of iliofemoral deep venous thrombosis (DVT) and post-thrombotic syndrome (PTS). Methods Fifty-four patients with 54 symptomatic limbs were identified by duplex scan and/or digital subtraction venography. Vascular access into the affected deep vein was achieved through four various approaches according to the evaluation of venography: transfemoral, transpopliteal, transankle (great saphenous vein (GSV) and small saphenous vein).Thirty-nine patients received catheter-directed thrombolysis (CDT), 24 patients with prartial lysis thrombosis and 15 PTS patients received balloon dilatation, and self-expanding stent was placed in 33 cases. All patients were followed for 3-15 months. Clinical follow-up by the referring physician included physical exam, international normalized ratio (INR), color duplex Doppler ultrasound (US) and/or venography. Results The technical success rate was 98%.Four various approaches according to the evaluation of venography: transfemoral (12/54), transpopliteal (27/54), transankle (great saphenous vein (GSV) (9/54) and small saphenous vein (6/54).In a total of 39 patients who received CDT, complete lysis was achieved in 15 cases (38%), and partial lysis was achieved in 24 (62%). The patients who had residual stenosis or PTS received balloon dilatation. Self-expanding stents were placed in 33 cases (61%). There was no perioperative mortality and no symptomatic pulmonary embolism founded. No symptomatic re-thrombosis of the treated venous segments was founded. Conclusions the results of this study indicate that the multi-approach endovascular technique is a safe and effective treatment of iliofemoral DVT and PTS. Every approach has its merit and demerit, and the selection mainly depends on the special circumstance.
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