经导管溶栓联合腔内成形术治疗急性下肢深静脉血栓形成早中期疗效评估
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摘要
目的评估经导管溶栓联合腔内成形术治疗急性下肢深静脉血栓形成的早中期疗效。方法选择2017年1月—2018年9月在我科经导管溶栓联合腔内成形术治疗的85例急性下肢深静脉血栓形成患者的临床资料进行回顾性分析。经溶栓后造影评估髂静脉狭窄程度决定是否行腔内血管成形术,并比较不同诱因下髂静脉支架植入的比率。随访期间,通过Villalta评分量表评估患者血栓形成后综合征发生情况,Vcss量表评估静脉临床症状严重程度;并采用彩色多普勒超声或深静脉造影评估髂静脉支架内通畅情况。结果术后肢体肿胀较术前明显缓解、管腔通畅率明显提高,差异均具有统计学意义(T1=14.2,T2=10.2,P均<0.001);本组患者髂静脉支架总植入率为17.6%(15/85),其中原发性血栓形成髂静脉支架植入率为30.0%(9/30),继发性血栓形成髂静脉支架植入率为10.9%(6/55),差异具有统计学意义(χ2=4.9,P<0.05)。术后76例患者获得随访(支架植入的患者均获得随访),随访时间3～24个月,15例髂静脉支架均通畅,其中1例(6.7%)患者出现对侧髂静脉血栓形成,经导管溶栓管腔获得再通; 11例(14.5%)患者出现不同程度的血栓形成后综合征的临床表现;全组无症状性肺动脉栓塞的发生。结论经导管溶栓联合腔内成形术治疗急性髂股静脉血栓效果良好,血栓清除率高,并可以维持较高的中期通畅率。
Objective To evaluate the early and medium-term efficacy of trans-catheter thrombolysis combined with endovenous angioplasty in the treatment of acute deep venous thrombosis of lower extremities.Methods The clinical data of 85 patients with acute deep venous thrombosis of lower extremities treated by trans-catheter thrombolysis combined with endovascular angioplasty in recent 2 years were collected. The degree of iliac vein stenosis was assessed by post-thrombolytic angiography to determine whether endovascular angioplasty was performed,and the rates of stent implantation in inferior iliac vein induced by different factors were compared.During the follow-up period,the incidence of post-thrombotic syndrome was assessed by Villalta scale,the severity of venous clinical symptoms was assessed by Vcss scale,and the patency of iliac vein stents was assessed by color Doppler ultrasound or deep venography. Results The swelling of limbs and the patency rate of lumen were significantly improved after operation( T1= 14.2,T2= 10.2,P< 0.001). The total implantation rate of iliac vein stents was 17. 6%( 15/85),including 30. 0%( 9/30) for primary thrombosis and 10. 9%( 6/55) for secondary thrombosis. The difference was statistically significant( χ~2= 4.9,P<0.05). 76 patients were followed up( all the patients who received stent implantation were followed up). The follow-up time ranged from 3 to 24 months. Fifteen iliac vein stents were unobstructed. One patient( 6. 7%) developed contralateral iliac vein thrombosis,which was re-canalized by catheter thrombolysis. Eleven patients( 14. 5%) developed different degrees of post-thrombotic syndrome. The whole group had no symptomatic pulmonary embolism. Conclusions Trans-catheter thrombolysis combined with endovascular angioplasty is effective in the treatment of acute iliofemoral vein thrombosis,with high thrombus clearance rate and high long-term patency rate.
Objective To evaluate the early and medium-term efficacy of trans-catheter thrombolysis combined with endovenous angioplasty in the treatment of acute deep venous thrombosis of lower extremities.Methods The clinical data of 85 patients with acute deep venous thrombosis of lower extremities treated by trans-catheter thrombolysis combined with endovascular angioplasty in recent 2 years were collected. The degree of iliac vein stenosis was assessed by post-thrombolytic angiography to determine whether endovascular angioplasty was performed,and the rates of stent implantation in inferior iliac vein induced by different factors were compared.During the follow-up period,the incidence of post-thrombotic syndrome was assessed by Villalta scale,the severity of venous clinical symptoms was assessed by Vcss scale,and the patency of iliac vein stents was assessed by color Doppler ultrasound or deep venography. Results The swelling of limbs and the patency rate of lumen were significantly improved after operation( T1= 14.2,T2= 10.2,P< 0.001). The total implantation rate of iliac vein stents was 17. 6%( 15/85),including 30. 0%( 9/30) for primary thrombosis and 10. 9%( 6/55) for secondary thrombosis. The difference was statistically significant( χ~2= 4.9,P<0.05). 76 patients were followed up( all the patients who received stent implantation were followed up). The follow-up time ranged from 3 to 24 months. Fifteen iliac vein stents were unobstructed. One patient( 6. 7%) developed contralateral iliac vein thrombosis,which was re-canalized by catheter thrombolysis. Eleven patients( 14. 5%) developed different degrees of post-thrombotic syndrome. The whole group had no symptomatic pulmonary embolism. Conclusions Trans-catheter thrombolysis combined with endovascular angioplasty is effective in the treatment of acute iliofemoral vein thrombosis,with high thrombus clearance rate and high long-term patency rate.
引文
[1] Kahn SR,Galanaud JP,Vedantham S,et al. Guidancefor the prevention and treatment of the post-thrombotic syndrome[J]. J Thromb Thrombolysis,2016,41(1):144-153.
[2] Kahn SR,Comerota AJ,Cushman M,et al. The Postthrombotic Syndrome:Evidence-Based Prevention,Diagnosis,and Treatment Strategies[J].Circulation,2014,130(18):1636-1661.
[3] Gro mmes J,Von TK,Wolf MD,et al. Catheter-directed thrombolysis in deep vein thrombosis:which procedural measurement predicts outcome?[J]. Phlebology,2014,29(suppl1):135-139.
[4]张皓.下肢深静脉血栓形成后综合征的治疗策略[J].中国血管外科杂志(电子版),2015,7(1):7-8.
[5]魏立春,侯培勇,李祺熠,等.急性下肢深静脉血栓形成置管溶栓治疗与血栓形成后综合征的相关性研究[J].中国血管外科杂志(电子版),2016,8(4):306-310.
[6] Porter JM,Moneta GL. Reporting standards in venous disease:an update. International Consensus Committee on Chronic Venous Disease[J].J Vasc Surg,1995,21(4):635-645.
[7] Liu B,Liu M,Yan L,et al.Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of acute pulmonary embolism and lower extremity deep venous thrombosis:A novel one-stop endovascular strategy[J]. J Int Med Res,2018,46(2):836-851.
[8] Robert B,Frank T,Anthony J,et al. Venous severity scoring:An adjunct to the venous outcome assessment[J].Vasc Surg,2000,31(6):1307-1312.
[9]钱宇轩.置管溶栓+支架植入治疗急性髂股静脉血栓的疗效分析[D].山西医科大学,2017.
[10] Kearon C,Akl EA,Ornelas J,et al.Antithrombotic therapy for VTE disease:CHEST guideline and expert panel report[J]. Chest,2016,149(2):315-352.
[11] Dumantepe M,Uyar I.The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis[J].Phlebology,2018,33(6):388-396.
[12] Zhu QH,Zhou CY,Chen Y,et al.Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis:a prospective study of single-session endovascular protocol[J].Eur J Vasc Endovasc Surg,2014,47(1):68-74.
[13] Enden T,Haig Y,Nils Einar K,et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis(the CaVenT study):a randomised controlled trial[J].Lancet,2012,379(9810):31-38.
[14] Haig Y,Enden T,Grtta O,et al.Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5-year follow-up results of an open-label,randomised controlled trial[J].Lancet Haematol,2016,3(2):e64-e71.
[15] Enden T,Klw NE,Sandvik L,et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis:results of an open randomized, controlled trial reporting on short-term patency[J]. J Thromb Haemost,2010,7(8):1268-1275.
[16] Wang H,Qi X,Luo H,et al. Catheter-directed thrombolysis through anterior tibial vein for treating acute extensive deep venous thrombosis[J].J Vasc Surg-Venous L,2018,6(6):681-688.
[17] Rathore A,Gloviczki P,Bjarnason H.Open surgical removal of iliac vein Wallstents with excision of pseudointima obstructing the contralateral iliac vein[J]. J Vasc Surg Venous L,2016,4(4):525-529.
[18]张喜成,奚斌,黄才安,等.髂静脉支架植入后髂腔静脉连接部流场分布的PIV测试[J].中华介入放射学电子杂志,2015,3(4):211-214.
[19] Murphy EH,Johns B,Varney E,et al. Deep venous thrombosis associated with caval extension of iliac stents[J]. J Vasc Surg Venous L,2017,5(1)8-17.
[20]高涌,周为民,余朝文,等.左髂静脉受压综合征的腔内治疗[J].蚌埠医学院学报,2006,31(6):587-589.
[21] Heit JA. Epidemiology of venous thromboembolism[J]. Nat Rev Cardiol,2015,12(8):464-474.
[2] Kahn SR,Comerota AJ,Cushman M,et al. The Postthrombotic Syndrome:Evidence-Based Prevention,Diagnosis,and Treatment Strategies[J].Circulation,2014,130(18):1636-1661.
[3] Gro mmes J,Von TK,Wolf MD,et al. Catheter-directed thrombolysis in deep vein thrombosis:which procedural measurement predicts outcome?[J]. Phlebology,2014,29(suppl1):135-139.
[4]张皓.下肢深静脉血栓形成后综合征的治疗策略[J].中国血管外科杂志(电子版),2015,7(1):7-8.
[5]魏立春,侯培勇,李祺熠,等.急性下肢深静脉血栓形成置管溶栓治疗与血栓形成后综合征的相关性研究[J].中国血管外科杂志(电子版),2016,8(4):306-310.
[6] Porter JM,Moneta GL. Reporting standards in venous disease:an update. International Consensus Committee on Chronic Venous Disease[J].J Vasc Surg,1995,21(4):635-645.
[7] Liu B,Liu M,Yan L,et al.Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of acute pulmonary embolism and lower extremity deep venous thrombosis:A novel one-stop endovascular strategy[J]. J Int Med Res,2018,46(2):836-851.
[8] Robert B,Frank T,Anthony J,et al. Venous severity scoring:An adjunct to the venous outcome assessment[J].Vasc Surg,2000,31(6):1307-1312.
[9]钱宇轩.置管溶栓+支架植入治疗急性髂股静脉血栓的疗效分析[D].山西医科大学,2017.
[10] Kearon C,Akl EA,Ornelas J,et al.Antithrombotic therapy for VTE disease:CHEST guideline and expert panel report[J]. Chest,2016,149(2):315-352.
[11] Dumantepe M,Uyar I.The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis[J].Phlebology,2018,33(6):388-396.
[12] Zhu QH,Zhou CY,Chen Y,et al.Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis:a prospective study of single-session endovascular protocol[J].Eur J Vasc Endovasc Surg,2014,47(1):68-74.
[13] Enden T,Haig Y,Nils Einar K,et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis(the CaVenT study):a randomised controlled trial[J].Lancet,2012,379(9810):31-38.
[14] Haig Y,Enden T,Grtta O,et al.Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5-year follow-up results of an open-label,randomised controlled trial[J].Lancet Haematol,2016,3(2):e64-e71.
[15] Enden T,Klw NE,Sandvik L,et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis:results of an open randomized, controlled trial reporting on short-term patency[J]. J Thromb Haemost,2010,7(8):1268-1275.
[16] Wang H,Qi X,Luo H,et al. Catheter-directed thrombolysis through anterior tibial vein for treating acute extensive deep venous thrombosis[J].J Vasc Surg-Venous L,2018,6(6):681-688.
[17] Rathore A,Gloviczki P,Bjarnason H.Open surgical removal of iliac vein Wallstents with excision of pseudointima obstructing the contralateral iliac vein[J]. J Vasc Surg Venous L,2016,4(4):525-529.
[18]张喜成,奚斌,黄才安,等.髂静脉支架植入后髂腔静脉连接部流场分布的PIV测试[J].中华介入放射学电子杂志,2015,3(4):211-214.
[19] Murphy EH,Johns B,Varney E,et al. Deep venous thrombosis associated with caval extension of iliac stents[J]. J Vasc Surg Venous L,2017,5(1)8-17.
[20]高涌,周为民,余朝文,等.左髂静脉受压综合征的腔内治疗[J].蚌埠医学院学报,2006,31(6):587-589.
[21] Heit JA. Epidemiology of venous thromboembolism[J]. Nat Rev Cardiol,2015,12(8):464-474.