球囊导管拖拉联合机械性抽吸治疗急性混合型下肢深静脉血栓

摘要

Objective To evaluate the balloon catheter extraction combined with mechanical aspiration thrombectomy therapy for acute lower extremity deep venous thrombosis (LEDVT) of mixed type.Methods The clinical data of 458 patients with acute lower extremity deep venous thrombosis of mixed type were analyzed retrospectively.Under local anesthesia and percutaneous puncture of the healthy femoral veins,the iliofemoral thrombi were aspirated using guide wires and 12-14F catheters.The femoropopliteal thrombi were extracted by Fogarty balloon catheters using large-lumen sheaths to aspirate the thrombi mechanically.After the thrombi were removed,angioplasty and stenting were performed on the stenotic or occluded common iliac veins demonstrated by venography.The thrombi below the popliteal veins were treated by thrombolysis.Results 139 patients with stenosis or occlusion of the common iliac veins were treated by adjunctive angioplasty and stent placement.411 patients (89.83％)were followed up for 16-70 months with median follow-up time of 35 months.The swelling and pain of affected limbs improved 1-3 days after the interventional treatment.The thrombi were completely resolved in 65.44％ of the patients.Immediately after treatment,the circumferences of the healthy and affected limbs at 15 cm above and below the knees differed by 1.34 ± 0.57 cm and 0.93 ± 0.32 cm,respectively.At 36 months after treatment,the circumferences differed by 0.53 ± 0.22 cm at 15 cm below the knees.Persistent edema and pigmentation occurred in 29.68％ and 13.87％ of patients with none suffering from leg ulcers.Color Doppler ultrasound showed patent veins in 90.02％ and normal valve function in 71.29％.The total effective rate was 100％ with 98.30％ excellent or good results.88.81％ of the patients had persistent excellent response at follow-up.Conclusions Balloon catheter extraction combined with mechanical aspiration thrombectomy therapy for LEDVT of mixed type can shorten the hospitalization period with excellent outcome and protection of venous valve function.%目的 探讨球囊导管拖拉联合机械性抽吸技术,治疗急性混合型下肢深静脉血栓形成(Lower extremity deep venous thrombosis,LEDVT)的临床效果及应用价值.方法 回顾性分析我院458例急性混合型LEDVT患者资料,采用局麻下经皮穿刺患侧股静脉,在导丝引导下插入12 ～ 14 F鞘管直接抽吸髂、股静脉内血栓；髋下股、腘静脉血栓,利用Fogarty取栓球囊导管将血栓拖拉至髂、股内,再经患侧股静脉机械性抽吸血栓.髂、股、腘静脉血栓清除后,对造影显示髂静脉狭窄或闭塞患者,行PTA或支架置入治疗；腘静脉以下残存血栓,行溶栓治疗.结果 术后1～3d患肢肿胀、疼痛均开始消退或减轻.血栓完全清除(Ⅰ级):65.44％；出院时健、患肢膝上、下15 cm处周径差:(1.34±0.57),(0.93±0.32) cm.139例合并髂总静脉狭窄或闭塞行PTA和支架置入辅助处理.411例随访16 ～ 70个月,中位随访时间35个月,随访率89.83％.术后36个月患肢膝下15 cm处周径差(0.53±0.22) cm;水肿、色素沉着、溃疡等后遗症发生率29.68％、13.87％、0％；彩超复查静脉通畅率和瓣膜功能正常率,分别为90.02％和71.29％；总有效率100％,优良率98.30％；随访疗效为优的比率占88.81％.结论 球囊导管拖拉联合机械性抽吸治疗急性混合型LEDVT,住院周期短,临床效果显著,尤其在保护静脉瓣膜功能方面是更为合理的治疗方法.