Minimally Invasive Endovascular Interventional Treatment for Lower Extremity Deep Venous Thrombosis with Stenosis or Obstruction of Iliac Vein_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Xiquan , WANG Yiping , ZHU Wei , LI Changhai , GUO Feng , DONG Ge , ZHANG Qing

Department of Interventional Vascular， The 148th Hospital of Chinese Peoplet’s Liberation Army， Zibo 255300， Shandong Province， China;

Corresponding author：

ZHANG Xiquan, Email: zyfbb19901024@sina.com

Keywords：

Iliac vein stenosis/obstruction; Mechanical aspiration thrombectomy; Stent implantation; Interve-ntional therapy

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Objective 　To discuss the clinical effect and value of stent placement combined with mechanical aspiration thrombectomy for acute iliofemoral venous thrombosis with iliac vein occlusion.
Methods 　From October 2004 to December 2011， interventional treatment were performed in 273 patients with acute iliofemoral venous thrombosis and iliac vein occlusion， including left side of 235 cases and right side of 38 cases. Antegrade femoral vein under local anesthesia， an 8-14F catheter was inserted into iliofemoral vein with the guidance of guide wire to aspirate thrombus directly， 53 patients used 18-24F large lumen sheath to aspirate thrombus. As for the femoralpopliteal vein thrombus， a “cross sheath” was inserted to affected iliac vein with the help of guide wire capture technique， a guide wire was introd-uced to popliteal vein， then a Fogarty balloon catheter was inserted and extracted thrombus to iliac vein， mechanical aspiration thrombectomy was performed again. After iliofemoral vein thrombus were removed completely， percutaneous transluminal angioplasty （PTA） and stenting were performed for stenosis or occlusion displayed by venography.
Results　 Thrombus removal were completely cleared （degreeⅢ） in 219 cases （80.22%）， partly cleared （degreeⅡ） in 49 cases （17.95%）， and minimal cleared （degreeⅠ） in 5 cases （1.83%）. The effect of stent placement：were cured in 235 cases （86.08%）， excellent in 29 cases （10.62%）， mild in 2 cases （2.57%）， and invalid in 7 cases （0.73%）. Total effective rate was 99.27% （271/273）， the average days in hospital was 7.5 days. Tumescence and pain of affected limb disappeared or relieved after interventional therapy for 1-2 days. The followe up effect：3-6 months， 7-12 months， 13-24 months， and 25-36 months after treatment of iliac vein patency were 94.87%，93.73%，87.08%，and 84.13% respectively.
Conclusion 　Mechanical aspiration thrombectomy combined with stent placement for acute lower extremity deep venous thrombosis and iliac vein obstruction is an effective and safe treatment for its notable therapeutic effect and the short hospitalization time.

Citation： ZHANG Xiquan,WANG Yiping,ZHU Wei,LI Changhai,GUO Feng,DONG Ge,ZHANG Qing. Minimally Invasive Endovascular Interventional Treatment for Lower Extremity Deep Venous Thrombosis with Stenosis or Obstruction of Iliac Vein. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(4): 412-417. doi: Copy

1.	Vedantham S， Thorpe PE， Cardella JF， et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J]. J Vasc Interv Radiol， 2006， 17(3)：435-448.
2.	Oğuzkurt L， Ozkan U， Gülcan O， et al. Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis using manual aspiration thrombectomy： long-term results of 139 patientsin a single center[J]. Diagn Interv Radiol， 2012，18(4)： 410-416.
3.	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.
4.	李晓强，段鹏飞，钱爱民，等. 介入联合手术治疗急性下肢深静脉血栓形成[J]. 中华普通外科杂志， 2006， 21(9)： 660-661.
5.	谷涌泉，张建，齐立行，等. 急性重症下肢深静脉血栓形成的外科治疗[J]. 中华医学杂志， 2009， 89(45)： 3186-3188.
6.	戎建杰，李晓强，桑宏飞，等. 血管腔内治疗下肢深静脉血栓形成[J]. 中华普通外科杂志， 2010， 25(2)：155-157.
7.	刘素芬，何运良. Cockett 综合征伴下肢深静脉血栓的治疗[J]. 临床放射学杂志， 2009， 28(3)：391-394.
8.	李天润，李选，翟国钧，等. 介入联合手术治疗急性髂股静脉血栓形成[J]. 中华普通外科杂志， 2011， 26(10)：845-848.
9.	赵堂海，王海波，郭明金，等. 取栓联合腔内血管成形术治疗急性下肢深静脉血栓形成[J]. 中华普通外科杂志， 2011， 26(3)：205-207.
10.	武国，陈开，郑江华. 下腔静脉滤器植入联合股静脉切开取栓治疗急性下肢深静脉血栓形成：附12例报告[J]. 中国普通外科杂志， 2010， 19(6)：703-704.
11.	Kwak HS， Han YM， Lee YS， et al. Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis：early and late results[J] . Vasc Interv Radiol， 2005， 16(6)： 815-822.
12.	Kearon C， Kahn SR， Agnelli G， et al. Antithrombotic therapy for venous thromboembolic disease： American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[J]. Chest， 2008， 133(6 Suppl)：454S-545S.
13.	Raffini L， Raybagkar D， Cahill AM， et al. May-Thurner syndrome (iliac vein compression) and thrombosis in adolescents[J]. Pediatr Blood Cancer， 2006， 47 (6)： 834-838.
14.	Mewissen MW， Seabrook GR， Meissner MH， et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis： report of a national multicenter registry[J]. Radiology， 1999，211(1)：39-49.
15.	Patel NH， Stookey KR， Ketcham DB， et al. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome[J]. J Vasc Interv Radiol， 2000， 11(10)： 1297-1302.
16.	Lamont JP， Pearl GJ， Patetsios P， et al. Prospective evaluation of endoluminal venous stents in the treatment of the May-Thurner syndrome[J]. Ann Vasc Surg， 2002， 16(1)： 61-64.
17.	Knipp BS， Ferguson E， Williams DM， et al. Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome[J]. Vasc Surg， 2007， 46(4)： 743-749.
18.	Vedantham S， Thorpe PE， Cardella JF， et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J]. J Vasc Interv Radiol， 2009， 20 (7 Suppl)： S227-S239.
19.	Chung JW， Yoon CJ， Jung SI， et al. Acute iliofemoral deep vein thrombosis： evaluation of underlying anatomic abnormalities by spiral CT venography[J]. J Vasc Interv Radiol， 2004， 15(3)： 249-256.
20.	Wells PS， Forster AJ. Thrombolysis in deep vein thrombosis： is there still an indication[J]. Throb Haemost， 2001， 86(1)： 499-508.
21.	张希全，王义平，潘晶晶，等. 急性下肢深静脉血栓形成的微创治疗[J]. 中国普外基础与临床杂志， 2012， 19(11)：1163-1169.
22.	张希全，王义平，潘晶晶等. 手动机械性血栓碎吸治疗急性下肢深静脉血栓疗效[J]. 介入放射学杂志， 2013， 22(1)：20-25.
23.	庄乃君，陈国平，顾建平，等. 急性下肢深静脉血栓形成解剖分布与抗凝、溶栓及介入治疗的疗效比较[J]. 中华放射学杂志， 2011， 45(12)：1194-1198.
24.	李晓强，钱爱民，汪忠镐. 下肢深静脉血栓形成的微创治疗[J]. 中国微创外科杂志， 2006， 6(11)： 820-823.
25.	刘辉，李晓强，段鹏飞，等. 左髂静脉压迫综合征的腔内治疗[J]. 中国综合临床， 2010， 26(1)： 68-70.
26.	Comerota AJ， Throm RC， Mathias SD， et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life[J]. J Vasc Surg， 2000， 32(1)： 130-137.

1. Vedantham S， Thorpe PE， Cardella JF， et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J]. J Vasc Interv Radiol， 2006， 17(3)：435-448.
2. Oğuzkurt L， Ozkan U， Gülcan O， et al. Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis using manual aspiration thrombectomy： long-term results of 139 patientsin a single center[J]. Diagn Interv Radiol， 2012，18(4)： 410-416.
3. 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.
4. 李晓强，段鹏飞，钱爱民，等. 介入联合手术治疗急性下肢深静脉血栓形成[J]. 中华普通外科杂志， 2006， 21(9)： 660-661.
5. 谷涌泉，张建，齐立行，等. 急性重症下肢深静脉血栓形成的外科治疗[J]. 中华医学杂志， 2009， 89(45)： 3186-3188.
6. 戎建杰，李晓强，桑宏飞，等. 血管腔内治疗下肢深静脉血栓形成[J]. 中华普通外科杂志， 2010， 25(2)：155-157.
7. 刘素芬，何运良. Cockett 综合征伴下肢深静脉血栓的治疗[J]. 临床放射学杂志， 2009， 28(3)：391-394.
8. 李天润，李选，翟国钧，等. 介入联合手术治疗急性髂股静脉血栓形成[J]. 中华普通外科杂志， 2011， 26(10)：845-848.
9. 赵堂海，王海波，郭明金，等. 取栓联合腔内血管成形术治疗急性下肢深静脉血栓形成[J]. 中华普通外科杂志， 2011， 26(3)：205-207.
10. 武国，陈开，郑江华. 下腔静脉滤器植入联合股静脉切开取栓治疗急性下肢深静脉血栓形成：附12例报告[J]. 中国普通外科杂志， 2010， 19(6)：703-704.
11. Kwak HS， Han YM， Lee YS， et al. Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis：early and late results[J] . Vasc Interv Radiol， 2005， 16(6)： 815-822.
12. Kearon C， Kahn SR， Agnelli G， et al. Antithrombotic therapy for venous thromboembolic disease： American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[J]. Chest， 2008， 133(6 Suppl)：454S-545S.
13. Raffini L， Raybagkar D， Cahill AM， et al. May-Thurner syndrome (iliac vein compression) and thrombosis in adolescents[J]. Pediatr Blood Cancer， 2006， 47 (6)： 834-838.
14. Mewissen MW， Seabrook GR， Meissner MH， et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis： report of a national multicenter registry[J]. Radiology， 1999，211(1)：39-49.
15. Patel NH， Stookey KR， Ketcham DB， et al. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome[J]. J Vasc Interv Radiol， 2000， 11(10)： 1297-1302.
16. Lamont JP， Pearl GJ， Patetsios P， et al. Prospective evaluation of endoluminal venous stents in the treatment of the May-Thurner syndrome[J]. Ann Vasc Surg， 2002， 16(1)： 61-64.
17. Knipp BS， Ferguson E， Williams DM， et al. Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome[J]. Vasc Surg， 2007， 46(4)： 743-749.
18. Vedantham S， Thorpe PE， Cardella JF， et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J]. J Vasc Interv Radiol， 2009， 20 (7 Suppl)： S227-S239.
19. Chung JW， Yoon CJ， Jung SI， et al. Acute iliofemoral deep vein thrombosis： evaluation of underlying anatomic abnormalities by spiral CT venography[J]. J Vasc Interv Radiol， 2004， 15(3)： 249-256.
20. Wells PS， Forster AJ. Thrombolysis in deep vein thrombosis： is there still an indication[J]. Throb Haemost， 2001， 86(1)： 499-508.
21. 张希全，王义平，潘晶晶，等. 急性下肢深静脉血栓形成的微创治疗[J]. 中国普外基础与临床杂志， 2012， 19(11)：1163-1169.
22. 张希全，王义平，潘晶晶等. 手动机械性血栓碎吸治疗急性下肢深静脉血栓疗效[J]. 介入放射学杂志， 2013， 22(1)：20-25.
23. 庄乃君，陈国平，顾建平，等. 急性下肢深静脉血栓形成解剖分布与抗凝、溶栓及介入治疗的疗效比较[J]. 中华放射学杂志， 2011， 45(12)：1194-1198.
24. 李晓强，钱爱民，汪忠镐. 下肢深静脉血栓形成的微创治疗[J]. 中国微创外科杂志， 2006， 6(11)： 820-823.
25. 刘辉，李晓强，段鹏飞，等. 左髂静脉压迫综合征的腔内治疗[J]. 中国综合临床， 2010， 26(1)： 68-70.
26. Comerota AJ， Throm RC， Mathias SD， et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life[J]. J Vasc Surg， 2000， 32(1)： 130-137.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Minimally Invasive Endovascular Interventional Treatment for Lower Extremity Deep Venous Thrombosis with Stenosis or Obstruction of Iliac Vein

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