Nonaka Daishi, Takase Hiroyuki, Machii Masashi, Ohno Kazuto
Department of Internal Medicine, Enshu Hospital, JA Shizuoka Kohseiren, Chuo, Naka-ku, Hamamatsu, Shizuoka, Japan.
Medicine (Baltimore). 2018 Jul;97(28):e11221. doi: 10.1097/MD.0000000000011221.
Inferior vena cava (IVC) thrombosis is an under-recognized entity that is associated with a mortality rate approaching twice that of lower extremity deep venous thrombosis (DVT). Thrombolytic therapy not only results in greater lysis, but also results in higher complication rates than anticoagulation alone. Catheter-directed thrombolysis (CDT), which is effective in accomplishing local resolution whilst reducing bleeding complications, has been established as an alternative treatment for patients with extensive DVT.
We report the case of a 70-year-old man who was admitted due to warmness, pain, and swelling in his left leg and a feeling of gait disturbance.
Contrast-enhanced computed tomography and venous ultrasonography revealed a pulmonary embolism and extensive DVT spreading to the IVC.
First, the patient was treated with fondaparinux. Since this was inadequate, he underwent CDT using a Fountain infusion catheter. Then, CDT was switched to direct oral anticoagulant (DOAC) treatment.
Both CDT and subsequent DOAC treatments dramatically improved the DVT. His subjective symptoms have disappeared, and no recurrence of thrombosis has been identified.
The present case showed the therapeutic effect of CDT, which preceded DOAC treatment, on an extensive DVT.
下腔静脉（IVC）血栓形成是一种未得到充分认识的疾病，其死亡率接近下肢深静脉血栓形成（DVT）的两倍。溶栓治疗不仅能实现更大程度的血栓溶解，但其并发症发生率也高于单纯抗凝治疗。导管直接溶栓（CDT）在实现局部血栓溶解的同时可减少出血并发症，已被确立为广泛DVT患者的一种替代治疗方法。
我们报告一例70岁男性患者，因左腿发热、疼痛、肿胀及步态紊乱感入院。
增强CT和静脉超声检查显示存在肺栓塞以及蔓延至下腔静脉的广泛DVT。
首先，患者接受磺达肝癸钠治疗。因效果不佳，遂使用Fountain灌注导管进行CDT治疗。之后，CDT治疗转换为直接口服抗凝剂（DOAC）治疗。
CDT治疗及随后的DOAC治疗均使DVT得到显著改善。患者主观症状消失，未发现血栓复发。
本病例显示了在DOAC治疗之前进行的CDT治疗对广泛DVT的治疗效果。
