血管内介入治疗滤器源性下腔-髂静脉长段阻塞8例

发布时间：2019-03-18 19:42

【摘要】：目的探讨血管内介入治疗滤器源性下腔-髂静脉长段阻塞的可行性和安全性。方法2014年1月至2016年10月采用经皮腔内血管成形术(PTA)和支架植入术治疗8例下腔静脉滤器置入后慢性下腔-髂静脉长段闭塞患者。收集8例患者临床及影像学资料,对血管内介入治疗方法、技术成功率、并发症发生率及随访情况进行统计分析。结果 8例患者闭塞段血管均成功开通。7例球囊成形结合植入支架术后即刻造影显示支架位置良好,支架内血流通畅,侧支血管减少;1例球囊成形结合支架植入术后发生急性支架内血栓形成,经导管直接溶栓2 d后复查造影显示支架内血栓完全溶解,血流恢复通畅。术后随访2~13个月,平均(4.7±3.9)个月。至末次随访,8例患者CT及下肢静脉造影均显示支架在位良好,其中3例支架内可见内膜轻度增生,但血流均通畅。结论滤器长期置入可导致慢性下腔-髂静脉长段闭塞。球囊成形及支架植入可有效开通闭塞血管,是一种安全可行的方法。
[Abstract]:Objective to evaluate the feasibility and safety of endovascular intervention in the treatment of filter-induced inferior vena cava-iliac vein occlusion. Methods from January 2014 to October 2016, percutaneous transluminal angioplasty (PTA) and stent implantation were performed in 8 patients with chronic long-segment occlusion of inferior vena cava-iliac vein after placement of inferior vena cava filter. The clinical and imaging data of 8 patients were collected, and the methods of intravascular intervention, the technical success rate, the incidence of complications and the follow-up were analyzed statistically. Results all the occluded vessels were successfully opened in 8 patients. 7 patients underwent balloon angioplasty combined with stent implantation immediately after angiographic examination showed that the stent was in good position, the blood flow in the stent was unobstructed, and the collateral vessels were reduced. Acute in-stent thrombosis occurred in 1 case after balloon angioplasty combined with stent implantation. Two days after direct catheter thrombolysis, angiography showed that the in-stent thrombus was completely dissolved and the blood flow recovered unobstructed. The follow-up period was (4.7 卤3.9) months (2 months) and 13 months (mean (4.7 卤3.9) months). At the end of the follow-up, CT and venography of the lower extremities showed that the stent was in good position in 8 cases, among which 3 cases showed mild intimal hyperplasia, but the blood flow was unobstructed. Conclusion long-term placement of filters can lead to long-term occlusion of the inferior vena cava-iliac vein. Balloon angioplasty and stent implantation can effectively open occluded blood vessels, it is a safe and feasible method.
【作者单位】：南京医科大学附属南京医院(南京市第一医院)介入血管科;南京大学医学院附属鼓楼医院血管外科;
【基金】：国家自然科学基金(81541061) 南京市卫生科技发展项目(YKK13105)
【分类号】：R543.6

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