经股腘静脉抽吸治疗下肢深静脉继发下腔静脉血栓

目的探讨经股静脉入路放置滤器治疗继发于下肢深静脉血栓(DVT)的下腔静脉血栓的可行性及安全性,评价滤器保护下血栓抽吸术的有效性。方法收集109例下肢DVT患者,其中11例血栓累及下腔静脉。于路径图引导下经健侧股静脉入路放置Aegisy滤器,打开但不解脱;再次穿刺股静脉,以8F指引导管抽吸下腔静脉内血栓;若血栓脱落于滤器内,尽量取出滤器内血栓后收回滤器,清洗后重新放置。经腘静脉入路抽吸髂股静脉内血栓,应用球囊或支架治疗髂静脉病变。14天内取出滤器。结果对11例DVT合并下腔静脉血栓者均成功取出髂股静脉及下腔静脉内血栓,8例术中发生血栓脱落;置入髂静脉支架5例,球囊扩张6例;8例取出滤器,3例永久植入滤器。随访6~35个月,下腔静脉及支架通畅,患者无活动后酸沉、肿胀,无色素沉着、静脉曲张等。结论经股静脉放置滤器治疗DVT合并下腔静脉血栓安全可行;在滤器保护下应用血栓抽吸术经股腘静脉入路治疗血栓快速、有效。

Percutaneous aspiration thrombectomy for treatment of inferior vena cava thrombi secondary to lower extremity deep venous thrombosis

Objective To explore the feasibility and safety of filter using transvenous femoral approach for treatment of inferior vena cava (IVC) thrombi secondary to lower extremity deep venous thrombosis (DVT), and to assess the efficacy of manual aspiration thrombectomy under the protection of IVC filter. Methods Totally 109 patients with lower extremity DVT were enrolled, and thrombi involved IVC in 11 patients. Aegisy filter was placed transfemorally under the guidance of road map, but the filter was not released from the pusher. Then IVC thrombi were aspirated with 8F guiding catheter introduced through the affected or the healthy femoral vein. If thrombus fell into the filter during aspiration, it should be aspirated as much as possible after being trapped by the filter, and the filter should be pulled out, washed completely, reintroduced and released. Then thrombi in iliac and femoral vein were aspirated through the affected popliteal vein. After aspiration, stenosis or occlusion of the iliac vein was treated with angioplasty or stenting. The filters were tried to removed within 14 days. Results IVC thrombi and lower extremity DVT of all 11 patients were successfully treated. Intraoperative fall off of part of IVC thrombi occurred in 8 patients. Obstruction or stenosis of iliac vein was treated with stenting (n=5) or balloon angioplasty (n=6). Filters were removed in 8 patients and permanently placed in 3 patients. The patients were followed up for 6 to 35 months. Patency of iliac vein and stent was identified, and there was no blood reflux of affected vein, nor pigmentation, varicose veins, swelling or pain. Conclusion For patients with IVC thrombi secondary to lower extremity DVT, it is safe and feasible to place retrievable IVC filter through the femoral vein. The thrombi could be rapidly and effectively treated with combined transfemoral and transpopliteal approaches for manual aspiration using large cavity catheter under the protection of filter.