CAJ | 학술논문

目的探讨AngioJet机械性血栓清除装置在急性髂股静脉血栓治疗中的临床价值.方法经血管超声、下肢静脉CTA明确诊断的15例下肢深静脉血栓患者,术前置入下腔静脉滤过器.除1例脑出血患者,均在术中使用尿激酶25万U(溶入100 ml生理盐水),通过AngioJet机械性血栓清除装置喷射模式进行血栓内喷射,等待15 min后行机械性血栓抽吸治疗.除外溶栓绝对禁忌证的患者,术后均保留溶栓导管进行持续溶栓治疗1~3 d,尿激酶用量25万~50万U/d.每天血管造影检查,如果血栓完全溶解并显示髂静脉受压综合征,则植入髂静脉支架,取出下腔静脉滤器并终止溶栓治疗.术后随访6个月,1、6个月时行下肢静脉CTA复查,术后口服抗凝治疗至少6个月.血栓清除评判标准:血栓清除率>90%为Ⅲ级、50%~90%为Ⅱ级、<50%为Ⅰ级.结果所有患者下肢髂股静脉血栓均进行了机械性血栓抽吸治疗,术后造影评估9支下肢髂股静脉血栓清除Ⅲ级、6支Ⅱ级、2支Ⅰ级.经过1~3 d溶栓治疗,12支下肢髂股静脉血栓清除Ⅲ级、5支清除Ⅱ级.其中7例发现左侧髂静脉受压综合征,予球囊扩张及支架植入治疗;12例溶栓结束后取出下腔静脉滤器.15例术后1个月、8例术后6个月CTA复查血栓无复发,无手术相关的严重并发症和死亡发生.结论AngioJet机械性血栓清除装置结合溶栓治疗急性髂股静脉血栓安全、有效.
목적 탐토AngioJet궤계성혈전청제장치재급성가고정맥혈전치료중적림상개치.방법 경혈관초성、하지정맥CTA명학진단적15례하지심정맥혈전환자,술전치입하강정맥려과기.제1례뇌출혈환자,균재술중사용뇨격매25만U(용입100 ml생리염수),통과AngioJet궤계성혈전청제장치분사모식진행혈전내분사,등대15 min후행궤계성혈전추흡치료.제외용전절대금기증적환자,술후균보류용전도관진행지속용전치료1~3 d,뇨격매용량25만~50만U/d.매천혈관조영검사,여과혈전완전용해병현시가정맥수압종합정,칙식입가정맥지가,취출하강정맥려기병종지용전치료.술후수방6개월,1、6개월시행하지정맥CTA복사,술후구복항응치료지소6개월.혈전청제평판표준:혈전청제솔>90%위Ⅲ급、50%~90%위Ⅱ급、<50%위Ⅰ급.결과 소유환자하지가고정맥혈전균진행료궤계성혈전추흡치료,술후조영평고9지하지가고정맥혈전청제Ⅲ급、6지Ⅱ급、2지Ⅰ급.경과1~3 d용전치료,12지하지가고정맥혈전청제Ⅲ급、5지청제Ⅱ급.기중7례발현좌측가정맥수압종합정,여구낭확장급지가식입치료;12례용전결속후취출하강정맥려기.15례술후1개월、8례술후6개월CTA복사혈전무복발,무수술상관적엄중병발증화사망발생.결론AngioJet궤계성혈전청제장치결합용전치료급성가고정맥혈전안전、유효.
Objective To evaluate the percutaneous AngioJet thrombectomy in the treatment of acute iliofemoral deep venous thrombosis (DVT) . Methods A total of 15 patients with lower extremity DVT verified by color Doppler ultrasound and computed tomographic angiography (CTA) were included in the study. Inferior vena cava filter was implanted in all patients prior to the thrombectomy. Percutaneous AngioJet thrombectomy was performed after a mixture of 250 000 U of urokinase in 100 ml of normal saline for local thrombolysis in all patients for approximately 15 minutes, except for 1 patient with cerebral hemorrhage. After the thrombectomy procedure, all patients received continuous transcatheter infusion of urokinase (250 000 to 500 000 U/d) for 1 to 3 days until the thrombosis was confirmed to be completely dissolved by angiography at 24, 48 and 72 hours. Those patients with May-Thurner syndrome underwent PTA and stent implantation. Inferior vena cava filter was retrieved from the patients post procedure and the thrombolytic therapy was discontinued. The patency rate of iliofemoral venous was assessed by CTA at 1 and 6 months after the procedure. Patients were discharged with oral anticoagulation regimen for at least 6 months. The following criteria are used in the evaluation of thrombolysis: grade Ⅰ<50% thrombus removal; gradeⅡ=50%to 90%thrombus removal, and gradeⅢ≥90%thrombus removal. Results All 15 patients were treated by AngioJet thrombectomy device for iliofemoral DVT. Angiography after the thrombectomyprocedure showed complete thrombus removal (>90%) in 9 limbs, substantial thrombus removal (50% to 90%) in 6 limbs, and partial thrombus removal (<50%) in the remaining 2 limbs. The average dosage of the urokinase used for thrombolytic therapy post thrombectomy was 1 030 000 U (500 000 to 2 750 000 U). GradeⅢ(complete) thrombolysis was achieved in 12 limbs and gradeⅡ(50%to 90%) thrombolysis in 5 of limbs. A total of 7 patients who had May-Thurner syndrome underwent PTA and stent implantation. Inferior vena cava filter was removed from 12 patients (except for 1 patient with cerebral hemorrhage and 2 patients with lung carcinoma). Venous patency was confirmed by CTA in all 15 patients at 1 month and 8 patients at 6 month after the treatment. There are no major complications related to the procedure. Conclusion Percutaneous AngioJet thrombectomy with adjunctive thrombolytic therapy is an effective and safe treatment modality in patients with acute iliofemoral vein thrombosis.