CAJ | 학술논문

目的探讨以经皮人工抽吸血栓清除术(MAT)作为主要的血栓清除方法,在MAT后立即行球囊扩张及支架置入术的一次性介入方案,治疗髂静脉受压综合征(IVCS)并发急性节段性髂股深静脉血栓形成(DVT)的可行性、疗效及安全性.方法前瞻性纳入IVCS并发急性节段性髂股DVT患者26例[女17例、男9例;年龄33～ 79岁,平均(55±13)岁].所有患者均表现为左下肢肿胀或疼痛.IVCS的确诊依靠CT血管成像.所有患者在确诊后即给予抗凝治疗,介入术后至少维持6个月.经患肢腘静脉入路行血管腔内治疗,MAT、球囊扩张及支架置入术在一次手术过程内完成.MAT后残留少许血栓者行经导管溶栓治疗(尿激酶80万单位维持12h).对患者的治疗情况进行随访.结果所有患者均成功施行一次性血管腔内治疗.手术时间45～ 90 min,平均(67±13)min.所有患者在MAT后血栓均达到完全清除,接近100％者24例,残留＜5％者2例,残留血栓经溶栓后完全溶解.MAT后静脉造影显示左髂静脉狭窄者24例,闭塞者2例.所有患者均成功开通左髂总静脉,共置入支架26枚,支架直径10～ 14 mm,长度60 ～ 100 mm.患肢症状完全缓解者25例,部分缓解者1例.住院时间2.0～4.0d,平均(2.7±0.3)d.随访时间12～ 25个月,平均(18±4)个月.1例在术后11个月出现支架内血栓形成,经溶栓后复通.1年初次通畅率和二次通畅率分别为96％(25/26)和100％(26/26).除5例患者在球囊扩张中出现一过性腰痛外,未见其他并发症.结论以MAT作为主要血栓清除方法、在MAT后立即行球囊扩张及支架置入术的一次性介入方案治疗IVCS并发急性节段性髂股DVT是可行的,近期疗效确切、安全.
목적 탐토이경피인공추흡혈전청제술(MAT)작위주요적혈전청제방법,재MAT후립즉행구낭확장급지가치입술적일차성개입방안,치료가정맥수압종합정(IVCS)병발급성절단성가고심정맥혈전형성(DVT)적가행성、료효급안전성.방법 전첨성납입IVCS병발급성절단성가고DVT환자26례[녀17례、남9례;년령33～ 79세,평균(55±13)세].소유환자균표현위좌하지종창혹동통.IVCS적학진의고CT혈관성상.소유환자재학진후즉급여항응치료,개입술후지소유지6개월.경환지객정맥입로행혈관강내치료,MAT、구낭확장급지가치입술재일차수술과정내완성.MAT후잔류소허혈전자행경도관용전치료(뇨격매80만단위유지12h).대환자적치료정황진행수방.결과 소유환자균성공시행일차성혈관강내치료.수술시간45～ 90 min,평균(67±13)min.소유환자재MAT후혈전균체도완전청제,접근100％자24례,잔류＜5％자2례,잔류혈전경용전후완전용해.MAT후정맥조영현시좌가정맥협착자24례,폐새자2례.소유환자균성공개통좌가총정맥,공치입지가26매,지가직경10～ 14 mm,장도60 ～ 100 mm.환지증상완전완해자25례,부분완해자1례.주원시간2.0～4.0d,평균(2.7±0.3)d.수방시간12～ 25개월,평균(18±4)개월.1례재술후11개월출현지가내혈전형성,경용전후복통.1년초차통창솔화이차통창솔분별위96％(25/26)화100％(26/26).제5례환자재구낭확장중출현일과성요통외,미견기타병발증.결론 이MAT작위주요혈전청제방법、재MAT후립즉행구낭확장급지가치입술적일차성개입방안치료IVCS병발급성절단성가고DVT시가행적,근기료효학절、안전.
Objective To evaluate the feasibility,safety and effectiveness of single-session endovascular treatment with manual aspiration thrombectomy (MAT) as first-line thrombus removal method for iliac vein compression syndrome (IVCS) with secondary acute segmental iliofemoral deep vein thrombosis (DVT).Methods Twenty-six patients [19 women,7 men,and mean age (55±13) years] with left-sided acute iliac-common femoral DVT secondary to IVCS were enrolled in this prospective clinical study.All patients presented with leg swelling or pains.The duration of symptoms ranged from 1 to 11 days (mean time 5.2 days).IVCS were diagnosed by CT venography.Anticoagulation therapy was given to all patients upon diagnosed and maintained for minimum 6 months after interventions.Endovascular treatment,consisted of MAT,balloon angioplasty and stent placement,was performed via ipsilateral popliteal vein and completed in the same setting.Overnight antegrade thrombolysis (urokinase 800 000 units lasting for 12 h) was performed in patients with residual thrombus after MAT.Patients were followed up on long-term.Results Single-session endovascular procedures were performed successfully in all patients.The mean procedure time was (67± 13) min (ranging from 45 to 90 min).Complete thrombus removal,including almost 100％ of removal in 24 patients and little residual thrombus (＜5％) in 2,was achieved after repeated MAT.Thrombolysis was used in these 2 patients.Complete symptomatic relief was achieved in 25 patients (96％) and partial relief in one.The hospital stay ranged from 2 to 4 days [mean (2.7 ±0.3) days].Recurrent thrombosis within the stent was observed in one case and recanalized with thrombolysis.The 1-year primary and secondary patency rate was 96％(25/26) and 100％(26/26),respectively.No symptomatic pulmonary embolization,bleeding and venous reflux were observed.Five patients complained about transitory low back pains during balloon angioplasty.The mean follow-up period was 18 months (12 to 25 months).Conclusion Single-session endovascular treatment with MAT as first-line thrombus removal method is feasible,safe and effective for IVCS with secondary acute segmental iliofemoral DVT.