Department of Vascular Surgery, Rigshospitalet and Gentofte Hospital, University of Copenhagen, Denmark.
J Vasc Interv Radiol. 2011 Jun;22(6):801-5. doi: 10.1016/j.jvir.2011.01.449. Epub 2011 Apr 2.
To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT).
From 2001 to 2009, 11 patients (median age, 32 y) with atresia of the IVC and acute iliofemoral DVT in 13 limbs were admitted for catheter-directed thrombolysis. Through a multiple-side hole catheter inserted in the popliteal vein, continuous pulse-spray infusion of tissue plasminogen activator and heparin was performed. Thrombolysis was terminated when all thrombus was resolved and venous outflow through the paravertebral collateral vessels was achieved. After thrombolysis, all patients received lifelong anticoagulation and compression stockings and were followed up at regular intervals.
Ultrasound or computed tomography revealed absence of the suprarenal segment of the IVC in two patients, and nine were diagnosed with absence of the infrarenal segment of the IVC. Median treatment time was 58 hours (range, 42-95 h). No deaths or serious complications occurred. Overall, complications were observed in four patients, one of whom required blood transfusion. Three patients were diagnosed with thrombophilia. Median follow-up was 37 months (range, 51 d to 96 mo). All patients had patent deep veins and one developed reflux in the popliteal fossa after 4 years. No thromboembolic recurrences were observed during follow-up.
Catheter-directed thrombolysis of patients with acute iliofemoral DVT and atresia of the IVC is a viable treatment option, as reasonable clinical outcomes can be obtained.
评估导管溶栓治疗下腔静脉(IVC)闭锁伴急性髂股深静脉血栓形成(DVT)的有效性和临床结局。
2001 年至 2009 年,11 例(中位年龄 32 岁)13 条肢体存在 IVC 闭锁伴急性髂股 DVT 的患者接受了导管溶栓治疗。通过插入在腘静脉的多孔导管进行组织型纤溶酶原激活物和肝素的连续脉冲喷射输注。当所有血栓溶解且通过椎旁侧支静脉实现静脉回流时,停止溶栓。溶栓后,所有患者均接受终身抗凝和压缩袜治疗,并定期随访。
超声或 CT 显示 2 例患者肾上段 IVC 缺失,9 例患者下肾段 IVC 缺失。中位治疗时间为 58 小时(范围,42-95 小时)。无死亡或严重并发症发生。共有 4 例患者出现并发症,其中 1 例需要输血。3 例患者诊断为血栓形成倾向。中位随访时间为 37 个月(范围,51 天至 96 个月)。所有患者深静脉通畅,1 例患者在 4 年后腘窝出现反流。随访期间无血栓栓塞复发。
对于急性髂股 DVT 伴 IVC 闭锁的患者,导管溶栓治疗是一种可行的治疗选择,可获得合理的临床结局。