Erdoes Luke S, Ezell Jessica B, Myers Stuart I, Hogan Michael B, LeSar Christopher J, Sprouse L Richard
Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Chattanooga, Tennessee 37403, USA.
Am Surg. 2011 Dec;77(12):1606-12. doi: 10.1177/000313481107701230.
Phlegmasia cerulea dolens (PCD) is limb-threatening. Traditional treatments are very morbid. We examine the efficacy of percutaneous treatment of PCD. Between May 2005 and September 2008, we treated 21 limbs in 20 patients with lower extremity PCD who were candidates for thrombolysis. Diagnosis was by clinical examination and duplex ultrasound. Catheter access to the deep venous system was obtained through a popliteal vein. Therapy used pulse spray thrombolysis with tissue plasminogen activator (tPA). Infusion catheters and adjunctive percutaneous techniques were used as indicated. Postoperatively, patients were treated with systemic anticoagulation, compression hose, and interval follow-up. Limbs were graded according to the CEAP classification. Twenty patients (13 male) were treated with a mean age of 55.8 years. Nine patients had hypercoagulable states, four May Thurner syndrome, three a history of cancer, one postcolon resection, one acute myocardial infarction, and one postfemoral vein puncture. All patients had resolution of PCD without the need for open surgery. The initial tPA dose was 19.5 mg with pulse spray thrombolysis. Infusion catheters were required in 18 patients and used for 16.1 hours (range, 8 to 36 hours) until complete thrombolysis. Venous angioplasty was necessary in 14 patients with nine of these requiring venous stents. One patient required above-knee amputation despite successful treatment of her PCD. Mean follow-up was 10.7 months (range, 1 to 39 months). All patients demonstrated no or minimal residual thrombus and intact valvular function and a mean clinical CEAP score of 2.4. Percutaneous treatment of PCD produced excellent results with minimal morbidity.
股青肿（PCD）会威胁肢体安全。传统治疗方法的创伤性很大。我们研究了经皮治疗PCD的疗效。在2005年5月至2008年9月期间，我们对20例下肢PCD患者的21条肢体进行了治疗，这些患者均适合溶栓治疗。通过临床检查和双功超声进行诊断。经腘静脉建立进入深静脉系统的导管通路。采用组织型纤溶酶原激活剂（tPA）进行脉冲喷射溶栓治疗。根据需要使用灌注导管和辅助经皮技术。术后，患者接受全身抗凝、穿加压弹力袜治疗，并定期随访。根据CEAP分类对肢体进行分级。20例患者（13例男性）接受了治疗，平均年龄为55.8岁。9例患者存在高凝状态，4例患有May-Thurner综合征，3例有癌症病史，1例为结肠切除术后，1例为急性心肌梗死，1例为股静脉穿刺术后。所有患者的PCD均得到缓解，无需进行开放手术。脉冲喷射溶栓时tPA的初始剂量为19.5mg。18例患者需要使用灌注导管，使用时间为16.1小时（范围为8至36小时），直至完全溶栓。14例患者需要进行静脉血管成形术，其中9例需要置入静脉支架。1例患者尽管PCD治疗成功，但仍需要进行膝上截肢。平均随访时间为10.7个月（范围为1至39个月）。所有患者均无或仅有少量残余血栓，瓣膜功能完好，临床CEAP平均评分为2.4。经皮治疗PCD取得了极佳的效果，且创伤极小。
