Meissner A J, Misiak A, Huszcza S, Ziemski J M
Pol Merkur Lekarski. 2000 Nov;9(53):767-71.
The aim of the study was to present general and haemorrhagic complications in 164 patients with acute DVT in ilio-femoral segment treated with different methods of pharmacological (heparins, streptokinase) and surgical (venous thrombectomy with temporary arterio-venous fistulae) therapy. There were no fatal complications in 48 UH or LMWH treated patients. One patient bled from stress stomach, one developed intramuscular haematoma, one mild pulmonary embolism and one rise of body. Among 84 patients treated with SK five fatal bleeding complications were recorded. From other non fatal complications we recorded one GI bleeding, one splenic rupture and three massive intramuscular haematoma. Three patients died in the early post thrombectomy period. Non fatal complications included one wound haematoma, two wound infection and one with marginal necrosis. The use of LMWH or UH treatment in acute ilio-femoral venous thrombosis is save as the frequency of massive bleeding and serious general complications is rather low. Fatal haemorrhagic episodes are the major hazards of thrombolytic therapy. Venous thrombectomy with temporary arterio-venous fistula may provide a good chance for treatment of acute proximal DVT associated with complete occlusion of the lumen of affected veins in patients with severe ischemic venous thrombosis or with contraindications to heparin treatment.
本研究的目的是呈现164例接受不同药物治疗(肝素、链激酶)和手术治疗(带临时动静脉瘘的静脉血栓切除术)的髂股段急性深静脉血栓形成患者的一般并发症和出血并发症。48例接受普通肝素或低分子肝素治疗的患者中无致命并发症。1例患者出现应激性胃部出血,1例出现肌内血肿,1例发生轻度肺栓塞,1例体温升高。在84例接受链激酶治疗的患者中,记录到5例致命性出血并发症。在其他非致命并发症中,我们记录到1例胃肠道出血、1例脾破裂和3例大面积肌内血肿。3例患者在血栓切除术后早期死亡。非致命并发症包括1例伤口血肿、2例伤口感染和1例边缘坏死。在急性髂股静脉血栓形成中使用低分子肝素或普通肝素治疗是安全的,因为大出血和严重一般并发症的发生率相当低。致命性出血事件是溶栓治疗的主要风险。对于严重缺血性静脉血栓形成或有肝素治疗禁忌证且受累静脉管腔完全闭塞的急性近端深静脉血栓形成患者,带临时动静脉瘘的静脉血栓切除术可能为治疗提供良好机会。