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：

 陈兆雷 ,  张喜成 , 孙元 , 潘广锐 , 徐淼

;

Corresponding author：

张喜成, Email: zhangxicheng@163.com

Keywords：

深静脉血栓形成; 置管溶栓术; 大隐静脉; 穿通支静脉

DOI：

10.7507/1007-9424.20140278

Video：

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目的探讨经大隐静脉-穿通支静脉入路行深静脉置管溶栓术(catheter-directed thrombolysis，CDT)治疗混合型下肢深静脉血栓形成(deep venous thrombosis，DVT）的临床疗效。方法对42例急性混合型下肢DVT患者，经踝大隐静脉-穿通支静脉入路，将溶栓导管置入深静脉行CDT治疗。回顾性分析该42例患者的临床资料，评价其溶栓疗效。结果 42例患者均成功经大隐静脉-穿通支静脉入路行CDT治疗。溶栓时间为5～7 d、(4.22±1.43) d；术后所有患者的肢体肿胀均明显好转；大腿周径差由术前的（7.76±1.72）cm缩减为术后的（2.21±0.91) cm（t=14.18，P＜0.01），小腿周径差由术前的（4.45±1.33）cm缩减为术后的(1.43±0.69）cm（t=11.92，P＜0.01），静脉通畅度评分由术前的12分降为术后的3分（Z=-3.03，P＜0.01）。术后发生穿刺处渗血2例，血尿2例，少量咯血1例。38例获访3～26个月，中位数为15个月。随访期间，1例发生支架远端重度狭窄，1例对侧下肢发生DVT。结论经大隐静脉-穿通支静脉入路行CDT治疗混合型下肢DVT，其操作简便，溶栓效率高，是临床值得推广的溶栓途径之一。

Citation： 陈兆雷, 张喜成, 孙元, 潘广锐, 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.	萧剑彬, 林少芒, 张智辉, 等.经小隐静脉置管溶栓治疗下肢深静脉血栓形成[J/CD]. 中国血管外科杂志:电子版, 2012, 4(1):26-28.
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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.	李晓强, 桑宏飞, 戎建杰, 等.介入治疗髂静脉狭窄或闭塞的远期效果观察[J/CD]. 中国血管外科杂志:电子版, 2010, 2(1):20-23.

1. Enden T, Haig Y, Kløw 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. 中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断与治疗指南(第2版)[J]. 中华外科杂志, 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. 萧剑彬, 林少芒, 张智辉, 等.经小隐静脉置管溶栓治疗下肢深静脉血栓形成[J/CD]. 中国血管外科杂志:电子版, 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. 李晓强, 桑宏飞, 戎建杰, 等.介入治疗髂静脉狭窄或闭塞的远期效果观察[J/CD]. 中国血管外科杂志:电子版, 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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