Clinical Study on Catheter-Directed Thrombolysis via Great Saphenous Vein for Mixed Deep Venous Thrombosis of Lower Extremity_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 陳兆雷 ,  張喜成 , 孫元 , 潘廣銳 , 徐淼

;

Corresponding?author：

張喜成, Email: zhangxicheng@163.com

Keywords：

深靜脈血栓形成; 置管溶栓術; 大隱靜脈; 穿通支靜脈

DOI：

10.7507/1007-9424.20140278

Video：

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目的探討經大隱靜脈-穿通支靜脈入路行深靜脈置管溶栓術(catheter-directed thrombolysis，CDT)治療混合型下肢深靜脈血栓形成(deep venous thrombosis，DVT）的臨床療效。方法對42例急性混合型下肢DVT患者，經踝大隱靜脈-穿通支靜脈入路，將溶栓導管置入深靜脈行CDT治療。回顧性分析該42例患者的臨床資料，評價其溶栓療效。結果 42例患者均成功經大隱靜脈-穿通支靜脈入路行CDT治療。溶栓時間為5～7 d、(4.22±1.43) d；術后所有患者的肢體腫脹均明顯好轉；大腿周徑差由術前的（7.76±1.72）cm縮減為術后的（2.21±0.91) cm（t=14.18，P＜0.01），小腿周徑差由術前的（4.45±1.33）cm縮減為術后的(1.43±0.69）cm（t=11.92，P＜0.01），靜脈通暢度評分由術前的12分降為術后的3分（Z=-3.03，P＜0.01）。術后發生穿刺處滲血2例，血尿2例，少量咯血1例。38例獲訪3～26個月，中位數為15個月。隨訪期間，1例發生支架遠端重度狹窄，1例對側下肢發生DVT。結論經大隱靜脈-穿通支靜脈入路行CDT治療混合型下肢DVT，其操作簡便，溶栓效率高，是臨床值得推廣的溶栓途徑之一。

Citation： 陳兆雷, 張喜成, 孫元, 潘廣銳, 徐淼. Clinical Study on Catheter-Directed Thrombolysis via Great Saphenous Vein for Mixed Deep Venous Thrombosis of Lower Extremity. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1158-1160. doi: 10.7507/1007-9424.20140278 Copy

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6.	蕭劍彬, 林少芒, 張智輝, 等.經小隱靜脈置管溶栓治療下肢深靜脈血栓形成[J/CD]. 中國血管外科雜志:電子版, 2012, 4(1):26-28.
7.	Park JY, Ahn JH, Jeon YS, et al.Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome[J]. Phlebology, 2013, 29(7):461-470.
8.	Narayan A, Eng J, Carmi L, et al.Iliac vein compression as risk factor for left-versus right-sided deep venous thrombosis:case-control study[J]. Radiology, 2012, 265(3):949-957.
9.	Kibbe MR, Ujiki M, Goodwin AL, et al.Iliac vein compression in an asymptomatic patient population[J]. J Vasc Surg, 2004, 39(5):937-943.
10.	Hartung O.Results of stenting for postthrombotic venous obstructive lesions[J]. Perspect Vasc Surg Endovasc Ther, 2011, 23(4):255-260.
11.	Raju S, Darcey R, Neglén P.Unexpected major role for venous stenting in deep reflux disease[J]. J Vasc Surg, 2010, 51(2):401-408.
12.	李曉強, 桑宏飛, 戎建杰, 等.介入治療髂靜脈狹窄或閉塞的遠期效果觀察[J/CD]. 中國血管外科雜志:電子版, 2010, 2(1):20-23.

1. Enden T, Haig Y, Kl?w NE, 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.
2. 中華醫學會外科學分會血管外科學組.深靜脈血栓形成的診斷與治療指南(第2版)[J]. 中華外科雜志, 2012, 50(7):611-615.
3. 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.
4. Protack CD, Bakken AM, Patel N, et al.Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement[J]. J Vasc Surg, 2007, 45(5):992-997.
5. Armon MP, Whitaker SC, Tennant WG.Catheter-directed thrombolysis of iliofemoral deep vein thrombosis.A new approach via the posterior tibial vein[J]. Eur J Vasc Endovasc Surg, 1997, 13(4):413-416.
6. 蕭劍彬, 林少芒, 張智輝, 等.經小隱靜脈置管溶栓治療下肢深靜脈血栓形成[J/CD]. 中國血管外科雜志:電子版, 2012, 4(1):26-28.
7. Park JY, Ahn JH, Jeon YS, et al.Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome[J]. Phlebology, 2013, 29(7):461-470.
8. Narayan A, Eng J, Carmi L, et al.Iliac vein compression as risk factor for left-versus right-sided deep venous thrombosis:case-control study[J]. Radiology, 2012, 265(3):949-957.
9. Kibbe MR, Ujiki M, Goodwin AL, et al.Iliac vein compression in an asymptomatic patient population[J]. J Vasc Surg, 2004, 39(5):937-943.
10. Hartung O.Results of stenting for postthrombotic venous obstructive lesions[J]. Perspect Vasc Surg Endovasc Ther, 2011, 23(4):255-260.
11. Raju S, Darcey R, Neglén P.Unexpected major role for venous stenting in deep reflux disease[J]. J Vasc Surg, 2010, 51(2):401-408.
12. 李曉強, 桑宏飛, 戎建杰, 等.介入治療髂靜脈狹窄或閉塞的遠期效果觀察[J/CD]. 中國血管外科雜志:電子版, 2010, 2(1):20-23.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study on Catheter-Directed Thrombolysis via Great Saphenous Vein for Mixed Deep Venous Thrombosis of Lower Extremity

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