接触性导管溶栓治疗急性左下肢深静脉血栓形成的单中心经验
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摘要
目的探讨采用接触性导管溶栓治疗急性左下肢深静脉血栓形成的临床疗效。方法收集我科2010年06月～2014年01月期间行导管溶栓治疗38例急性左下肢深静脉血栓形成的临床资料,所有患者均采用接触性导管溶栓治疗。比较治疗前后双下肢周径差、溶栓并发症、血栓后综合征等疗效指标。结果所有患者经溶栓治疗后痊愈或好转后出院,出院前双下肢髌骨下10 cm周径差由3.74±0.94 cm下降为1.85±0.76 cm;双下肢髌骨上10 cm周径差径差由7.31±0.91 cm下降为4.35±1.28 cm,经配对样本t检验,P<0.05,治疗效果显著。平均随访18±9.3个月,随访成功率100%,随访期间10例(26.3%)患者诊断为血栓后综合征。结论采用导管溶栓治疗急性下肢深静脉血栓形成的疗效确切、血栓后综合征发生率较低,是安全有效的治疗手段。
Objective To investigate the feasibility and efficacy of catheter-directed thrombolysis(CDT)in treatment for deep venous thrombosis(DVT)of lower limbs.Methods The clinical data of38 patients with acute DVT from June 2010 to January 2014 in the First Peoples′ Hospital of Foshan were analyzed retrospectively.All patients were treated with CDT.Then,thrombolysis and intermittent compression therpy were performed again.Limb circumference difference between preoperative and postoperative,complications of thrombolysis and post-thrombotic syndrome(PTS) were compared between before and after treatment.Result All patients undergo thrombolysis were cured or improved.Thecircumference difference 10 cm below patella between bilateral limbs was reduced from(3.74±0.94)cm to(1.85±0.76)cm.The circumference difference 10 cm above patella between bilateral limbs was reduced from(7.31±0.91)cm to(4.35±1.28)cm.The duratioins of follow-ups for(18±9.3)months and the follow up rate was 100%.The PTS was diagnosed in 10 patients followed.Conclusion Using two catheterdirected thrombolysis combined with intermittent compression therapy has a definite curative effect on DVT of low extremities and the incidence of PTS was low.
Objective To investigate the feasibility and efficacy of catheter-directed thrombolysis(CDT)in treatment for deep venous thrombosis(DVT)of lower limbs.Methods The clinical data of38 patients with acute DVT from June 2010 to January 2014 in the First Peoples′ Hospital of Foshan were analyzed retrospectively.All patients were treated with CDT.Then,thrombolysis and intermittent compression therpy were performed again.Limb circumference difference between preoperative and postoperative,complications of thrombolysis and post-thrombotic syndrome(PTS) were compared between before and after treatment.Result All patients undergo thrombolysis were cured or improved.Thecircumference difference 10 cm below patella between bilateral limbs was reduced from(3.74±0.94)cm to(1.85±0.76)cm.The circumference difference 10 cm above patella between bilateral limbs was reduced from(7.31±0.91)cm to(4.35±1.28)cm.The duratioins of follow-ups for(18±9.3)months and the follow up rate was 100%.The PTS was diagnosed in 10 patients followed.Conclusion Using two catheterdirected thrombolysis combined with intermittent compression therapy has a definite curative effect on DVT of low extremities and the incidence of PTS was low.
引文
[1]Fleck D,Albadawi H,Shamoun F,et al.Catheter-directed thrombolysis of deep vein thrombosis:literature review and practice considerations[J].Cardiovasc Diagn Ther,2017,7(Suppl 3):S228-S237.
[2]雷锋锐,李晓强,钱爱民,等.导管接触性溶栓治疗滤器置人后下腔静脉血栓形成[J].中华医学杂志,2014,94(28):2197-2200.
[3]Eklof B,Perrin M,Delis KT,et al.Updated terminology of chronic venous disorders:The VEIN-TERM transatlantic interdisciplinary consensus document[J].J Vascul Surg,2009,49(2):498-501.
[4]Kahn SR,Shrier I,Julian JA,et al.Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis[J].Ann Intern Med,2008,149(10):698-707.
[5]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].JVasc Interv Radiol,2009,20(7 Suppl):S227-S239.
[6]Sharifi M,Bay C,Nowroozi S,et al.Catheter-directed thrombolysis with argatroban and tPA for massive iliac and femoropopliteal vein thrombosis.cardiovascular and interventional radiology[J].Cardiovasc Intervent Radiol,2013,36(6):1586-1590.
[7]B?kgaard N,Broholm R,Just S.Indications for stenting during thrombolysis[J].Phlebology,2013,28 Suppl 1:112-116.
[8]Srinivas BC,Patra S,Reddy B,et al.Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis:a prospective study with venous Doppler follow-up at 1.year[J].Cardiovasc Interv Ther,2015,30(4):320-326.
[9]Whitlock RP,Sun JC,Fremes SE,et al.Antithrombotic and thrombolytic therapy for valvular disease:antithrombotic therapy and prevention of thrombosis:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e576S-e600S.
[10]Kahn SR,Comerota AJ,Cushman M,et al.The postthrombotic syndrome:evidence-based prevention,diagnosis,and treatment strategies:a scientific statement from the American Heart Association[J].Circulation,2014,130(18):1636-1661.
[11]Enden T,Haig Y,Kl?w 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.
[12]Michiels JJ,Michiels JM,Moossdorff W,et al.Diagnosis of deep vein thrombosis,and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014[J].World J Cri Care Med,2015,4(1):29-39.
[13]Kahn S.Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome[J].JThromb Haemost,2009,7(5):884-888.
[14]Haig Y,Enden T,Gr?tta O,et al.Post.thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5.year follow.up results of an open-label,randomised controlled trial[J].Lancet Haematol,2016,3(2):e64-e71.
[15]Vedantham S,Goldhaber SZ,Julian JA,et al.Pharmacomechanical catheter-directed thrombolysis for deepvein thrombosis[J].N Engl J Med,2017,377(23):2240-2252.2019-03-26
[2]雷锋锐,李晓强,钱爱民,等.导管接触性溶栓治疗滤器置人后下腔静脉血栓形成[J].中华医学杂志,2014,94(28):2197-2200.
[3]Eklof B,Perrin M,Delis KT,et al.Updated terminology of chronic venous disorders:The VEIN-TERM transatlantic interdisciplinary consensus document[J].J Vascul Surg,2009,49(2):498-501.
[4]Kahn SR,Shrier I,Julian JA,et al.Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis[J].Ann Intern Med,2008,149(10):698-707.
[5]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].JVasc Interv Radiol,2009,20(7 Suppl):S227-S239.
[6]Sharifi M,Bay C,Nowroozi S,et al.Catheter-directed thrombolysis with argatroban and tPA for massive iliac and femoropopliteal vein thrombosis.cardiovascular and interventional radiology[J].Cardiovasc Intervent Radiol,2013,36(6):1586-1590.
[7]B?kgaard N,Broholm R,Just S.Indications for stenting during thrombolysis[J].Phlebology,2013,28 Suppl 1:112-116.
[8]Srinivas BC,Patra S,Reddy B,et al.Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis:a prospective study with venous Doppler follow-up at 1.year[J].Cardiovasc Interv Ther,2015,30(4):320-326.
[9]Whitlock RP,Sun JC,Fremes SE,et al.Antithrombotic and thrombolytic therapy for valvular disease:antithrombotic therapy and prevention of thrombosis:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e576S-e600S.
[10]Kahn SR,Comerota AJ,Cushman M,et al.The postthrombotic syndrome:evidence-based prevention,diagnosis,and treatment strategies:a scientific statement from the American Heart Association[J].Circulation,2014,130(18):1636-1661.
[11]Enden T,Haig Y,Kl?w 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.
[12]Michiels JJ,Michiels JM,Moossdorff W,et al.Diagnosis of deep vein thrombosis,and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014[J].World J Cri Care Med,2015,4(1):29-39.
[13]Kahn S.Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome[J].JThromb Haemost,2009,7(5):884-888.
[14]Haig Y,Enden T,Gr?tta O,et al.Post.thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5.year follow.up results of an open-label,randomised controlled trial[J].Lancet Haematol,2016,3(2):e64-e71.
[15]Vedantham S,Goldhaber SZ,Julian JA,et al.Pharmacomechanical catheter-directed thrombolysis for deepvein thrombosis[J].N Engl J Med,2017,377(23):2240-2252.2019-03-26