经膝下途径导管直接溶栓治疗混合型下肢深静脉血栓形成

目的:评价经膝下(Below the Knee, BTK)途径导管直接溶栓(Catheter-Directed Thrombolysis, CDT)治疗混合型下肢深静脉血栓形成(Deep Vein Thrombosis, DVT)的安全性和有效性。方法:回顾性分析2013年1月至2017年10月于徐州市肿瘤医院介入科接受经BTK途径CDT治疗的38例急性混合型DVT患者临床资料,其中男性患者26例,女性患者12例,年龄54±11岁。结果:技术成功率为100%。经小隐静脉穿刺途径28例,小隐静脉切开途径4例,胫后静脉切开途径4例,胫后静脉穿刺途径2例。行CDT前,所有患者均接受临时可回收滤器置入,并于术后2周内取出。36名患者DVT血栓溶解成功(Ⅱ和Ⅲ级)。2名未获得血栓溶解成功的患者,从症状发生到CDT时间均大于10天。对13例患者(左侧10例,右侧3例)进行髂静脉球囊扩张和支架植入。围手术期出现切口渗血4例,切开部位麻木5例,没有新发肺栓塞和大出血发等主要并发症。平均随访时间为2年(1个月-4年),28例患者超过1.5年。2例患者由于未服用华法林而出现反复髂股DVT。随访期间通畅率和PTS率分别为81.6%(31/38)和31.6%(12/38)。结论:采用经BTK途径行CDT治疗混合型DVT是安全有效的,围手术期及随访期间结果满意,是一种值得推广的方法。

Catheter-Directed Thrombolysis for Acute Entire Limb Deep Vein Thrombosis via Below the Knee Access

ABSTRACT Objective: To evaluate the safety and efficacy of Catheter-Directed Thrombolysis (CDT) in the treatment of mixed deep venous thrombosis(DVT) via the Below the Knee(BTK) access. Methods: The clinical data of patients with acute mixed DVT treated with CDT by the BTK access in the department of interventional radiology, Xuzhou Cancer Hospital from January 2013 to October 2017 were retrospectively analyzed. The patients included 26 males and 12 females with an average age of 54±11 years old. Results: The technical success rate was 100%. Interventional procedures were performed through small saphenous vein puncture (28 cases), small saphenous vein incision(4 cases), posterior tibial vein incision (4 cases), and posterior tibial vein puncture (2 cases). All CDTs were im- planted with a temporarily recyclable filter preoperatively and removed within 2 weeks after surgery. Thirty-six patients achieved suc- cessful thrombolysis(Grades II and III). Two patients who did not gain thrombolytic success had a time of more than 10 days from symp- tom onset to CDT. 13 patients(10 cases on the left and 3 cases on the right) underwent balloon dilatation and stent implantation. During perioperative period, there were 4 cases of incision bleeding, 5 cases of numbness at the incision site, and no major complications such as new pulmonary embolism and major hemorrhage. The average follow-up time was 2 years(1 month to 4years) and 28 patients ex- ceeded 1.5 years. Two patients had repeated patellae DVT due to not taking warfarin. The patency rate and PTS rate during follow-up were 81.6%(31/38) and 31.6%(12/38), respectively. Conclusion: The use of CDT via BTK approach in DVT is feasible and safe and may be considered an alternative to traditional CDT approach.