经皮血栓碎吸联合血管成形治疗髂静脉压迫综合征并深静脉血栓形成

摘要

Objective To investigate the clinical effect of mechanical aspiration thrombectomy with adjunctive PTA and stenting for iliac vein compression syndrome with lower extremity deep venous thrombosis.Materials and Methods The clinical data of 184 patients who had iliac vein compression syndrome with lower extremity DVT were analyzed retrospectively The healthy femoral vein was accessed,then a 12-14 F sheath was introduced via a guide wire to aspirate thrombus in the iliofemoral; For the cases with femoropopliteal thrombus,the thrombus was macerated and pulled by Fogarty balloon catheter,then performing mechanical aspiration thrombectomy.After thrombus removal,PTA and stenting were performed on stenosis or occlusion of common iliac vein that displayed on venography.Results The thrombus removal rate:Grade Ⅲ 80.89％ and Grade Ⅱ 19.02％.The circumference of affected limbs at 15 cm above and below knee joints were (43.9±4.7) cm and (31.5±4.1)cm,respectively,after being discharged from hospital,the differences were statistical significance (t=6.43,t=5.79,both P=0.000)compared to be hospitalized.The follow-up result:the treatment efficiency was 97.75％.The stent patency rate of postoperation at 6,12,and 24 months were 97.19％,94.94％,92.13％,respectively,on sonography or digital subtract angiography.Conclusion Mechanical aspiration thrombectomy with adjunctive venoplasty for iliac vein compression syndrome with lower extremity deep venous thrombosis is an effective and safe therapy having notable therapeutic effect in short / middle-term follow-up and shorter hospitalization time.%目的 探讨经皮血栓碎吸联合血管成形治疗髂静脉压迫综合征并下肢深静脉血栓形成的临床效果.资料与方法 回顾性分析184例髂静脉压迫综合征并下肢深静脉血栓形成的病例资料.经皮穿刺患侧股静脉,在导丝引导下采用12～14 F鞘管抽吸髂、股静脉内血栓；对于股、腘静脉血栓,利用Fogarty球囊导管将血栓碎解、拖拉至髂静脉内,再行机械性血栓抽吸术.对髂静脉严重狭窄或闭塞者,行经皮腔内血管成形术或支架置入治疗.结果 本组血栓清除率Ⅲ级80.98％,Ⅱ级19.02％；出院时患肢膝上、下15 cm周径为(43.9±4.7) cm、(31.5±4.1) cm,与入院时相比其间差异有统计学意义(t=6.43,t=5.79,均P=0.000).随访6～24个月,治疗有效率为97.75％；178例支架置入病人术后6、12、24个月彩色多普勒超声或DSA复查,支架通畅率为97.19％、94.94％、92.13％.结论 血栓碎吸联合血管成形治疗髂静脉压迫综合征并下肢深静脉血栓形成,其近、中期疗效显著,住院时间短,是一种安全有效的介入治疗方法.