血管内介入治疗滤器源性下腔-髂静脉长段阻塞8例

摘要

Objective To evaluate the feasibility and safety of endovascular intervention for the treatment of filter-related long segment obstruction of IVC and iliac vein.Methods From January 2014 to October 2016,a total of 8 patients with filter-related chronic long segment obstruction of IVC and iliac vein were treated with percutaneous transcatheter angioplasty (PTA) and stent implantation.The clinical data and imaging materials were collected.The endovascular interventional treatment methods were discussed,and the technical success rate,procedure-related complications and follow-up results were analyzed.Results Successful recanalization of the obstructed IVC-iliac vein segment was achieved in all 8 patients.In 7 patients,angiography performed immediately after PTA and stent implantation showed that the blood flow in the stent was smooth and the collateral vessels were decreased.In one patient,acute in-stent thrombosis occurred after PTA and stent implantation,then catheter-directed thrombolysis had to be adopted,and angiography performed 2 days later indicated that in-stent thrombosis was completely dissolved and the blood flow resumed smoothly.The patients were followed up for 2-13 months,with a mean of (4.7±3.9) months.Reexamination with both CT and venography of lower limb showed that the stent was kept in good position to the last visit in all 8 patients.Slight intimal hyperplasia was observed in 3 patients,but the blood flow was unobstructed.Conclusion Long term implantation of filter may cause filter-related chronic long segment obstruction of IVC and iliac vein.PTA with stent implantation is a safe and feasible method to effectively open the occluded vessels.%目的 探讨血管内介入治疗滤器源性下腔-髂静脉长段阻塞的可行性和安全性.方法 2014年1月至2016年10月采用经皮腔内血管成形术(PTA)和支架植入术治疗8例下腔静脉滤器置入后慢性下腔-髂静脉长段闭塞患者.收集8例患者临床及影像学资料,对血管内介入治疗方法、技术成功率、并发症发生率及随访情况进行统计分析.结果 8例患者闭塞段血管均成功开通.7例球囊成形结合植入支架术后即刻造影显示支架位置良好,支架内血流通畅,侧支血管减少;1例球囊成形结合支架植入术后发生急性支架内血栓形成,经导管直接溶栓2d后复查造影显示支架内血栓完全溶解,血流恢复通畅.术后随访2～13个月,平均(4.7±3.9)个月.至末次随访,8例患者CT及下肢静脉造影均显示支架在位良好,其中3例支架内可见内膜轻度增生,但血流均通畅.结论 滤器长期置入可导致慢性下腔-髂静脉长段闭塞.球囊成形及支架植入可有效开通闭塞血管,是一种安全可行的方法.