Schwarzbach M H M, Schumacher H, Böckler D, Fürstenberger S, Thomas F, Seelos R, Richter G M, Allenberg J-R
Department of Vascular and Endovascular Surgery, University of Heidelberg, D-69120 Heidelberg, Germany.
Eur J Vasc Endovasc Surg. 2005 Jan;29(1):58-66. doi: 10.1016/j.ejvs.2004.09.022.
To evaluate the efficacy of surgical thrombectomy combined with endovascular reconstruction for acute ilio-femoral/caval venous thrombosis.
Twenty consecutive patients with acute, symptomatic ilio-femoral/-caval thrombosis underwent valve-preserving thrombectomy with immediate endovascular repair between October 1996 and October 2003. Thrombectomy was classified by intraoperative venography as: TYPE I=complete, TYPE II=partial, TYPE III=complete with stenosis other than thrombus, TYPE IV=permanent occlusion. TYPEs I and IV were excluded from this analysis because endovascular repair was not performed.
Left-sided venous thrombosis predominated (90%). Lesions were located in the common iliac vein (85%), the external iliac vein (10%), and the inferior vena cava (5%). Three TYPE II lesions and 17 TYPE III lesions (11 spurs, one hypoplasia, one fibrosis, one haematoma, and three others) were diagnosed. Catheter-directed recanalisation (thrombectomy/thrombolysis) resolved TYPE II lesions in three patients. Balloon angioplasty (one patient), iliac stenting (15 patients [two with thrombolysis]), and caval stenting (one patient) were employed in TYPE III stenoses. No serious complication or death occurred. Mean follow-up was 21 months. Of 20 patients clinical results were excellent in 18 patients who maintained patency of their reconstructed iliac veins. Primary and secondary patency rates were 80 and 90%, respectively.
Ilio-caval venous obstructions detected intraoperatively can be reconstructed in a one-stage combined procedure. The specific endovascular approach depends on the type of residual venous obstruction. Excellent mid-term results indicate that the proposed thrombectomy classification (TYPE I-IV) and treatment algorithm optimises the results in selected patients with symptomatic venous thrombosis.
评估手术取栓联合血管腔内重建术治疗急性髂股/腔静脉血栓形成的疗效。
1996年10月至2003年10月，连续20例急性症状性髂股/腔静脉血栓形成患者接受了保留瓣膜的取栓术并立即进行血管腔内修复。术中静脉造影将取栓术分为：I型=完全取栓，II型=部分取栓，III型=除血栓外伴有狭窄的完全取栓，IV型=永久性闭塞。本分析排除I型和IV型，因为未进行血管腔内修复。
左侧静脉血栓形成占主导（90%）。病变位于髂总静脉（85%）、髂外静脉（10%）和下腔静脉（5%）。诊断出3例II型病变和17例III型病变（11处骨刺、1处发育不全、1处纤维化、1处血肿和3处其他病变）。导管引导下再通（取栓/溶栓）使3例患者的II型病变得到解决。III型狭窄采用球囊血管成形术（1例患者）、髂动脉支架置入术（15例患者[2例同时进行溶栓]）和腔静脉支架置入术（1例患者）。未发生严重并发症或死亡。平均随访21个月。20例患者中，18例重建髂静脉保持通畅，临床结果良好。一期通畅率和二期通畅率分别为80%和90%。
术中发现的髂腔静脉梗阻可通过一期联合手术进行重建。具体的血管腔内治疗方法取决于残余静脉梗阻的类型。良好的中期结果表明，所提出的取栓分类（I-IV型）和治疗方案可优化有症状静脉血栓形成患者的治疗效果。
