急性下肢深静脉血栓形成22例综合治疗的临床分析

目的:探讨急性下肢深静脉血栓形成的治疗方法。方法:对22例急性下肢深静脉血栓形成患者综合治疗的临床资料进行回顾性分析。结果:采用手术取栓配合超声消融及区域性溶栓的综合治疗方法。22例中除1例股浅静脉小段狭窄,1例遗留深静脉瓣膜功能不全外,其余均获满意疗效。结论:手术取栓配合超声消融等微创技术是治疗急性下肢深静脉血栓形成的最佳选择。     

超声消融治疗动脉闭塞性硬化症疗效观察

目的 应用Acolysis血栓超声消融仪对下肢动脉硬化闭塞症(ASO)进行治疗，评价其疗效。方法 10例ASO患者共11条肢体均经血管造影确诊，病程在15d至3年。在DSA下用Acolysis血栓消融仪行腔内超声消融治疗。配合抗凝，祛聚，扩张血管等治疗。多普勒超声随访。结果 10例患者除1例肢体因动脉再次闭塞外，9例患者10条闭塞的动脉管腔均经一次治疗后再通，随访1～3个月，10条血管保持通畅，有效率达90％。结论 血管内超声消融技术，可以有效地消融外周动脉的陈旧性血栓和斑块，重新恢复闭塞血管的血流，从而能明显改善临床症状，挽救肢体。     

介入治疗急性下肢深静脉血栓的疗效观察

【目的】探讨介入治疗急性下肢深静脉血栓的临床疗效。【方法】选择急性下肢深静脉血栓患者168例,经股静脉或经右颈内静脉置入腔静脉滤器后,均行静脉置管溶栓治疗,溶栓治疗结束前复查肺动脉造影及下肢静脉造影,术后6个月复查血管超声。【结果】置入腔静脉滤器168枚均一次性释放成功,释放过程平均耗时1．9min。168例患者溶栓成功率100％,平均溶栓时间9．68d;98．8％（166／168）。患者肢体肿胀、疼痛症状消失或减轻;血栓直径消融75％～100％91例;血栓直径消融50％～75％47例;血栓直径消融小于50％30例,随访期间下肢静脉血栓直径与溶栓治疗结束时相比无增大。【结论】下腔静脉滤器置入术及下肢深静脉置管溶栓术治疗急性下肢深静脉血栓形成具有介入操作技术成功率较高、症状改善明显、血栓消融程度高、损伤小、安全性好的优点。     

两种微创治疗下肢静脉曲张的观察护理

目的观察微创方法治疗下肢静脉曲张患者的护理体会。方法本组115例下肢静脉曲张病人用微创治疗（激光腔内闭合治疗55例，射频腔内闭合治疗60例），采用小切口大隐静脉高位结扎、血管腔内原位闭合，属支及交通支电凝、结扎观察术后效果、并发症等。结果所有病人下肢肿胀、酸痛、乏力在手术后1个月逐步消失；皮肤色素沉着在术后1个月减轻，3个月逐步恢复。并发症的发生，激光和射频治疗组分别为：16.36％（9／55），16．67％（10／60）；全部病例无下肢深静脉血栓形成和切口感染。小腿皮肤麻木3～6个月逐步恢复，其余并发症在1个月内均恢复。结论微创治疗具有明显的优越性，但与传统手术一样，同样可能发生一些并发症，因此术后要严密观察和精心护理，积极配合医师完成整个治疗过程。     

彩色超声多普勒在下肢深静脉血栓形成中的诊断价值

目的探讨彩色超声多普勒在下肢深静脉血栓形成中的应用价值。方法 回顾采用彩色超声多普勒诊断的52例下肢深静脉血栓形成患者的临床资料。重点分析彩色超声多普勒显示的下肢深静脉血栓的大小、形成部位以及血栓形成后对血管腔梗阻的程度。结果 52例患者中,左下肢深静脉血栓42例,右下肢深静脉血栓8例,双下肢深静脉血栓2例,其中完全性梗阻38例,不完全梗阻14例。结论应用彩色多普勒在下肢深静脉血栓形成中具有较高的诊断价值。     

超声消融在慢性深静脉血栓形成治疗中的应用

目的 评价静脉超声消融在治疗慢性下肢深静脉血栓形成中的作用。方法 38例慢性深静脉血栓患者接受了静脉内超声消融治疗，超声消融时间为12～24min，平均18min，术后应用肝素抗凝，应用静脉趋动器促进血液回流。结果 38例髂股静脉闭塞中31例完全再通，再通达81％，7例部分再通，部分再通达19％。31例完全再通者随访24例，15冽未安放支架者，10例发生再闭塞，达65％，9例安放支架者2冽发生再闭塞，再闭塞22％。结论 超声消融可以再通已经闭塞的髂股静脉并为进一步进行球囊扩张和安放内支架创造了条件。     

《2003年第54届ASA年会知识更新精粹》已出版

急性下肢深静脉血栓形成是周围血管病变常见病之一，我们于1998—12～2003—09月开展了静脉内超声消融配合其他介入疗法共治疗76例急性下肢深静脉血栓形成，获得了较好疗效，现报道如下。     

中西医结合治疗早期下肢深静脉血栓形成16例临床观察

下肢深静脉血栓（DVT）形成是指下肢深静脉腔内急性非化脓性炎症，并伴有静脉内血栓形成，导致静脉回流障碍而引起血栓远端静脉高压的疾病，是临床常见的疾病，大多始发于腓肠肌静脉丛或髂静脉及股静脉段。血栓形成后，除少数自行消融或局限于发生部位外，大部分扩展至整个肢体深静脉主干，若不能及时诊断和处理，多演变为血栓形成综合征，长时期影响患者的生活质量，部分患者还会并发肺栓塞，造成严重后果，甚至影响生命。我院采用中西医结合治疗早期下肢深静脉血栓形成患者16例，现报告如下：     

彩色多普勒超声在诊断下肢深静脉血栓形成中的应用

目的：应用彩色多普勒超声观察下肢深静脉血栓形成不同时期的声像图特征、栓塞程度及临床转归。方法：检查46例患有下肢深静脉血栓患者的下肢静脉，二维观察血管内径、管壁回声、管腔内回声，辅以探头加压试验、Valsalva试验及挤压肢体远端试验，观察其血流情况，濒谱形态及测量血流速度。结果：完全性阻塞、不完全性阻塞及再通性血栓，彩色多普勒均有特征表现，超声诊断符合率93．3％。结论：彩色多普勒超声诊断下肢深静脉血栓形成敏感性和特异性高，并能判断栓塞程度、观察血栓不同时期的表现，指导临床治疗方案，具有其它影像学不可替代的优势。     

下肢深静脉血栓形成15例的超声诊断分析

目的探讨下肢深静脉血栓形成的超声图像特征、诊断要点。方法研究对象为临床确诊下肢深静脉血栓形成患者15例，应用彩色多普勒超声诊断仪，观察下肢静脉的结构及血流状态，记录管腔内径及栓塞程度，观察充盈情况。结果急性血栓11例，亚急性、慢性血栓4例。结论彩色超声多普勒对于诊断具有很高的敏感性，可为临床诊断提供可靠的客观依据。     

Long-Term Clinical Outcome of Right Bundle Branch Radiofrequency Catheter Ablation for Treatment of Bundle Branch Reentrant Ventricular Tachycardia

This study assessed the long-term outcome of patients undergoing radiofrequency ablation of the right bundle for bundle branch reentrant ventricular tachycardia. Bundle branch reentrant tachycardia was diagnosed in 16 patients (ejection fraction 31%± 15%) who underwent electrophysiology study in our laboratory. All patients had His-Purkinje system conduction delay with mean HV interval of 68 ± 8 ms. After ablation, right bundle branch block developed in 15 patients. One patient developed complete heart block, which was anticipated. One patient died of heart failure 9 months after ablation. Two patients were successfully bridged to heart transplantation 0.5 and 13 months, respectively, after ablation. Two patients received implantable defibrillators for other ventricular tachycardias. One patient had syncope 11 months after ablation, but there was no evidence of ventricular tachycardia or heart block in repeat electrophysiology study. This patient died suddenly 29 months after ablation. The remaining nine patients were alive and well for a mean follow-up of 19 ± 10 months. Radiofrequency ablation of the right bundle branch is an effective therapy for treatment of bundle branch reentrant ventricular tachycardia. Survival is excellent provided that other types of ventricular tachycardia, when present, are treated as well. This technique maybe helpful in management of patients who have unacceptable frequent shocks from their implanted defibrillators and may be helpful in avoiding implantation of such a device completely in others. In some patients with terminal heart failure and incessant ventricular tachycardia, this procedure can function as a bridge to cardiac transplantation.     

Utility of lower-extremity duplex sonography in patients with venous thromboembolism.

PURPOSE: We evaluated the utility of venous duplex ultrasonography (VDUS) of the lower extremities in patients with pulmonary embolism (PE) and studied the distribution of venous thrombi in deep vein thrombosis (DVT) patients with and without PE. METHODS: We retrospectively reviewed medical records of all inpatients with a final diagnosis of PE or DVT between 1989 and 2000. RESULTS: Venous thrombosis was detected by VDUS in 229 patients (191 without PE and 38 with PE). The left leg only was involved in 50% of patients (p < 0.05), the right leg only in 33%, and both legs in 17%. The overall distribution of veins affected by DVT was: popliteal vein, 77%; superficial femoral vein, 76%; common femoral vein, 65%; posterior tibial vein, 23%; external iliac vein, 21%; common iliac vein, 9%; great saphenous vein, 7%; and inferior vena cava, 2%. A single venous site was involved in 22% of patients. External iliac vein thrombosis was more frequent in patients with DVT only (24%) than with PE and DVT (5%) (p < 0.05). The venous obstruction was partial in 14% of patients. VDUS of the asymptomatic leg was positive in 14% of patients with unilateral symptoms of DVT, all of whom also had DVT in the symptomatic leg. VDUS was positive for DVT in 90% of patients with PE and concomitant pain or edema of the leg, compared to only 20% of PE patients with no symptoms of DVT. CONCLUSIONS: Sonography should be the first diagnostic test for patients suspected of having PE with any sign or symptom related to DVT. VDUS of the asymptomatic leg is unnecessary in the diagnosis and management of DVT. Omitting the superficial femoral vein examination would lead to some decrease in the sensitivity of VDUS.     

急性血管阻塞性疾病的超声诊断

３９例临床怀疑为急性周围血管阻塞性疾病的患者接受血管超声检查。超声诊断并明确定位上肢或下肢急性深静脉血栓形成（ＤＶＴ）１３例，急性动脉阻塞７例（其中５例栓塞，１例血栓形成，１例髂动脉夹层）。超声诊断后不作血管造影术，立即对患者进行治疗。１例临床怀疑急性下肢动脉栓塞患者超声检查阴性。１８例超声排除ＤＶＴ诊断而不予抗凝治疗的患者，在临床随访中均未发生肺栓塞。     

Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism

Summary. Background: Previous studies are mixed as to whether patients with unprovoked pulmonary embolism (PE) have a higher rate of venous thromboembolism (VTE) recurrence after anticoagulation is discontinued than patients with unprovoked deep vein thrombosis (DVT). Objectives: To determine whether patients with unprovoked PE have a higher rate of VTE recurrence than patients with unprovoked DVT in a prospective multicenter cohort study. Patients/Methods: Six hundred and forty‐six patients with a first episode of symptomatic unprovoked VTE were treated with heparin and subsequent oral anticoagulation for 5–7 months, and were followed every 6 months for recurrent VTE after their anticoagulant therapy was discontinued. Results: Of 646 patients, 194 had isolated PE, 339 had isolated DVT, and 113 had both DVT and PE. After a mean of 18 months of follow‐up, there were 91 recurrent VTE events (9.5% annualized risk of recurrent VTE in the total population). The crude recurrent VTE rate for the isolated PE, isolated DVT and DVT and PE groups were 7.7%, 16.5% and 17.7%, respectively. The relative risk of recurrent VTE for isolated DVT vs. isolated PE was 2.1 (95% confidence interval 1.2–3.7). Conclusions: This study has demonstrated that patients with a first episode of unprovoked isolated DVT are 2.1 times more likely to have a recurrent VTE episode than patients with a first episode of unprovoked isolated PE. These findings need to be considered when determining the optimal duration of anticoagulant therapy for patients with unprovoked VTE.     

Comparison of the Villalta post‐thrombotic syndrome score in the ipsilateral vs. contralateral leg after a first unprovoked deep vein thrombosis

Summary. Background: Post‐thrombotic syndrome (PTS) is the most frequent complication of a deep vein thrombosis (DVT). International guidelines recommend assessing PTS with the Villalta scale, a clinical measure that incorporates venous symptoms and signs in the leg ipsilateral to a DVT. However, these signs and symptoms are not specific for PTS and their prevalence and relevance in the contralateral leg have not previously been studied. Methods: Using data from the REVERSE prospective multicentre cohort study, we compared the Villalta total score and prevalence of venous signs and symptoms in the ipsilateral vs. contralateral leg in patients with a first, unilateral DVT 5 to 7 months previously. Results: Among the 367 patients analyzed, the mean Villalta score was higher in the ipsilateral than in the contralateral leg (mean ± standard deviation [SD] 3.7 [3.4] vs. 1.9 [2.5], respectively; P < 0.0001). Villalta scores in the ipsilateral and contralateral legs were strongly correlated (r = 0.68; P < 0.0001). Ipsilateral PTS (defined by a Villalta total score > 4) was present in 31.6% (n = 116) of patients. Among these, 39.7% (n = 46) of patients had a Villalta score > 4 in the contralateral leg, and the distribution of Villalta symptoms and signs components was similar between the legs. Conclusions: Villalta scores in the ipsilateral and contralateral legs are strongly correlated. Almost half of cases considered to be PTS might reflect pre‐existing symptomatic chronic venous disease. Alternatively, patients with pre‐existing chronic venous disease might be more prone to developing PTS after a DVT. Performing a bilateral assessment of Villalta scores at the acute phase of DVT could be of clinical interest from a diagnostic, prognostic and therapeutic point of view.     

Deep vein thrombosis after ischemic stroke: rationale for a therapeutic trial

Deep venous thrombosis (DVT) in the legs occurs in 23% to 75% of patients with acute ischemic stroke, and pulmonary embolism accounts for about 5% of deaths. New heparinoid substances, lacking the hazards of more established anticoagulants, raise the question of DVT prophylaxis for these patients. Two hundred fifty consecutive acute ischemic stroke patients were evaluated for the presence of DVT of the legs in a feasibility study for a trial of low-molecular-weight heparin prophylaxis. Forty-nine patients were found suitable for the study, of whom 11 (22.5%) developed DVT. All patients underwent clinical examination, I-125 fibrinogen leg scanning, and impedance plethysmography. Five patients were sufficiently alert and without serious neurologic deficits to justify DVT prophylaxis. Recent advances in noninvasive diagnostic techniques to detect DVT early and the development of relatively safe heparinoid compounds increase the need for a prophylactic study in patients with ischemic stroke.     

Endoluminal radiofrequency ablation of the long saphenous vein (VNUS closure) -- a minimally invasive management of varicose veins

This report describes our clinical experience with the VNUS closure. This is a percutaneous catheter-based procedure in which the vein is ablated from within by resistive heating. We performed the UK's first radiofrequency closure without a high tie in March 1999. Between then and March 2000, 40 patients (35:5 F:M, age 22-92, mean 45.1 years) had 59 legs treated. All operations were for varicose veins, eight legs were recurrent, four legs had concomitant ulceration and three legs were treated with additional subfascial endoscopic perforator ligation (SEPS). Only one treatment failure occurred in our series. In all the other successfully treated limbs the long saphenous vein remained without flow on Duplex scan evaluation during our 1 year follow-up. All patients were fully mobile within 12 hours and all patients returned to their daily activities or to work within 72 hours. On questioning, no patient reported pain related to the thigh procedure. This new technique of radiofrequency ablation provides a minimal access alternative to the classical high saphenous tie and strip. Our results to date suggest that this procedure results in minimal post-operative pain and allows early return to normal activities.     

Long-Term Follow-Up After Right Atrial Radiofrequency Catheter Treatment of Paroxysmal Atrial Fibrillation

Catheter ablation of paroxysmal atrial fibrillation using long linear lesions in the right atrium is still under investigation, and its long-term follow-up is unknown. Methods: Thirty-six men and nine women (aged 51 ± 12 years) with symptomatic daily episodes of AF for 6 ± 5 years despite the use of 4.7 ± 1.5 antiarrhythmic drugs were studied between July 1994 and January 1996. Progressively longer ablation lines were performed in 3 groups of 15 consecutive patients each, using a 14-electrode catheter or a single-electrode dragging technique. Success was defined as atrial fibrillation elimination or recurrence for no longer than 6 hours over 3 months of observation. Patients who had fewer than 6 hours of atrial fibrillation per month were considered "improved." Medium- (11 ± 4 months) and long-term (26 ± 5 months) results were assessed clinically from a patient's diary and from Holter recordings. Results: After a follow-up of 11 months, 24 patients had a favorable result of the ablation procedure with or without additional antiarrhythmic drug therapy, representing 53% of the original cohort. After 26 ± 5 months of follow-up, these successful results were reduced to 17 patients (37%). Conclusions: After linear atrial ablation, a significant long-term attrition of arrhythmia-free patients was observed. This may be due to a combination of disease progression, incomplete linear block, and ineffective ablation of arrhythmogenic triggers.     

Hepatocellular carcinoma recurrence after percutaneous ablation therapy: helical CT patterns

Background: To categorize the helical computed tomographic (CT) intrahepatic recurrence patterns of hepatocellular carcinoma (HCC) after treatment with percutaneous ablation procedures. Methods: Double-phase helical CT studies of 67 patients with HCC recurrence were reviewed. The study population had undergone percutaneous ablation therapy procedures (multisession or single-session ethanol injection therapy, radiofrequency thermal ablation therapy, and interstitial laser photocoagulation therapy) for 120 HCC nodules. Results: Four patterns were defined. (A) Enhancing tissue within the edge of the ablated nodule on arterial phase images (ingrowth): this pattern was seen in five treated lesions (4.2% of all treated nodules) in five patients (7.5% of all patients with recurrence) 3–7 months after treatment (mean = 4 months). (B) Enhancing tissue around the treated nodule but continuously to its border on arterial-phase images (outgrowth): this pattern was found in 12 (10%) treated lesions in 12 patients (18%) 3–6 months after ablation (mean = 4 months). (C) Enhancing tissue within the same segment of the treated nodule on arterial phase images (spread): this pattern was detected in 10 (8%) treated lesions in 10 patients (15%) 3–6 months after treatment (mean = 5 months). (D) Enhancing tissue within different segments from the treated nodule on arterial phase images (progression): this pattern was identified in 34 patients (51%) with 53 (44%) treated tumors 5–22 months after ablation (mean = 8 months). A mixed pattern was found in six subjects (9%) with seven (6%) treated nodules. Among the 61 patients with a nonmixed pattern, there were 85 treated nodules with persistent necrosis, 17 treated nodules with local recurrence (pattern A or B), and 107 new nodules due to nonlocal recurrence (pattern C or D). Portal phase enhanced images and especially unenhanced images showed a lower detection rate and a lower lesion-to-liver conspicuity score (for all patterns but mainly for pattern C). Conclusion: Four patterns of recurrence after percutaneous ablation procedures can be categorized on double-phase helical CT and are best depicted on arterial phase images. Knowledge of these patterns is relevant for early detection and may be helpful in understanding the recurrence mechanism. Received: 25 September 2000/Accepted: 15 November 2000     

Incidence of Deep Venous Thrombosis Associated with Femoral Venous Catheterization

Objective : To determine in adult medical patients the incidence of deep venous thrombosis (DVT) resulting from femora] venous catheterization (FVC).
Methods : A prospective, observational study was performed at a 420-bed community teaching hospital. Hep-arin-coated 7-Fr 20-cm femoral venous catheters were inserted unilaterally into a femoral vein. Each contra-lateral leg served as a control site. Age, gender, number of FVC days. DVT risk factors, administration of DVT prophylaxis, and DVT formation and site were tabulated for each patient. Venous duplex sonography was performed bilaterally on each patient within 7 days of femoral venous catheter removal.
Results : Catheters were placed in 29 men and 13 women. Femoral DVT was identified by venous duplex sonography in 11 (26.2%) of the FVC legs and none (0%) in the control legs. Posterior tibial and popliteal DVT was identified in both the FVC and control legs of 1 patient. DVT formation at the site of FVC insertion was highly significant (p = 0.005). There were no statistically significant associations with age (p = 0.42), gender (p = 0.73), number of DVT risk factors (p = 0.17), number of FVC days (p = 0.89), or DVT prophylaxis (p — 099).
Conclusion : Placement of femoral catheters for central venous access is associated with a significant incidence of femoral DVT as detected by venous duplex sonography criteria at the site of femoral venous catheter placement. Physicians must be aware of this risk when choosing this vascular access route for adult medical patients. Further studies to assess the relative risk for DVT and its clinical sequelae when using the femoral vs other central venous catheter routes are indicated.