Go Michael R, Baril Donald T, Leers Steven A, Chaer Rabih A
Division of Vascular Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA.
J Endovasc Ther. 2009 Apr;16(2):233-7. doi: 10.1583/08-2649.1.
To present two cases of lower extremity paraplegia associated with acute iliocaval thrombosis successfully treated with thrombolysis.
A 36-year-old morbidly obese woman with a history of lower extremity deep venous thrombosis (DVT), pulmonary embolism (PE), and inferior vena cava (IVC) filter placement 4 years prior presented with back pain. Imaging showed iliac vein engorgement consistent with thrombosis and common femoral vein DVT bilaterally. She was started on intravenous heparin but developed marked lower extremity weakness while anticoagulated. Given these progressive symptoms, systemic tissue plasminogen activator was administered, with subsequent improvement over 48 hours. At 6-month follow-up, she was living independently, with near normal strength and sensation in her lower extremities. While hospitalized following an assault, a 55-year-old man with a history of factor V Leiden, DVT/PE, and prior IVC filter developed marked left lower extremity swelling, which progressed to severe bilateral lower extremity edema and mottling, along with sensory and motor loss of the lower extremities. Lower extremity duplex confirmed extensive DVT extending from the level of the iliac veins down to the tibial vessels. He underwent successful pharmacomechanical thrombectomy. At 6 months, he was walking normally, with no residual neurological symptoms and no evidence of DVT.
Acute cauda equina syndrome related to iliocaval thrombosis and epidural variceal engorgement presenting with complete paraplegia has not to our knowledge been reported. Pharmacomechanical thrombectomy affords an opportunity to achieve complete iliocaval clearance in a single procedure and is well-suited to cases in which neural infarction is imminent.
介绍两例与急性髂股静脉血栓形成相关的下肢截瘫病例，经溶栓治疗成功治愈。
一名36岁的病态肥胖女性，有下肢深静脉血栓形成（DVT）、肺栓塞（PE）病史，4年前曾植入下腔静脉（IVC）滤器，现出现背痛。影像学检查显示髂静脉充血，符合血栓形成，双侧股总静脉也有DVT。她开始接受静脉肝素治疗，但在抗凝期间出现明显的下肢无力。鉴于这些进行性症状，给予全身组织型纤溶酶原激活剂治疗，随后在48小时内病情有所改善。在6个月的随访中，她能够独立生活，下肢力量和感觉接近正常。一名55岁男性，有因子V莱顿突变、DVT/PE病史且曾植入IVC滤器，在一次袭击事件后住院期间，出现明显的左下肢肿胀，随后发展为严重的双侧下肢水肿和瘀斑，同时伴有下肢感觉和运动丧失。下肢血管超声检查证实广泛的DVT，从髂静脉水平延伸至胫血管。他接受了成功的药物机械性血栓清除术。6个月时，他行走正常，无残留神经症状，也没有DVT的迹象。
据我们所知，尚未有与髂股静脉血栓形成和硬膜外静脉曲张充血相关的急性马尾综合征导致完全截瘫的报道。药物机械性血栓清除术为在单一手术中实现完全的髂股静脉清除提供了机会，非常适合即将发生神经梗死的病例。
