Marache P, Asseman P, Jabinet J L, Prat A, Bauchart J J, Aisenfarb J C, Lesenne M, Jude B, Thery C
Service de Soins Intensifs, Hôpital Cardiologique, Lille, France.
Am Heart J. 1993 Feb;125(2 Pt 1):362-6. doi: 10.1016/0002-8703(93)90013-y.
Systemic thrombolysis is less than optimal in total occlusions of the iliac vein in which patency is 20% or less. We describe an interventional therapeutic procedure that may be effective in such cases. We selected 18 patients (average age, 29.5 years; range, 16 to 71 years) with complete iliac vein occlusion that persisted after 24 to 48 hours of systemic thrombolysis (streptokinase 100,000 U/hr). The ipsilateral femoral vein was punctured, and a guide wire was gently advanced through the thrombus into the inferior vena cava. Multiple inflations were performed with a balloon catheter that was advanced on the wire. A temporary vena cava filter was placed as a protection against possible embolic migration. Systemic thrombolysis was administered for 24 to 48 hours. Control venography and pulmonary angiography were performed. Venography showed good recanalization in seven cases, incomplete recanalization in five cases, and failure in six cases. Patency was maintained for a long time (15.6 months). In conclusion, (1) percutaneous transluminal venous angioplasty is a valuable adjunct to systemic thrombolysis when the latter alone fails; (2) segmental flow and mechanical obstruction were the critical factors, since the pharmaceutical factors were held constant, and (3) a more aggressive incremental interventional strategy warrants consideration.
对于髂静脉完全闭塞且通畅率在20%及以下的情况，全身溶栓治疗效果欠佳。我们描述了一种在此类病例中可能有效的介入治疗方法。我们选择了18例患者（平均年龄29.5岁；范围16至71岁），这些患者在全身溶栓（链激酶100,000 U/小时）24至48小时后仍存在髂静脉完全闭塞。穿刺同侧股静脉，将导丝轻柔地穿过血栓进入下腔静脉。沿导丝推进球囊导管进行多次扩张。放置临时腔静脉滤器以防止可能的栓子迁移。进行全身溶栓24至48小时。进行对照静脉造影和肺血管造影。静脉造影显示7例再通良好，5例部分再通，6例失败。通畅维持了较长时间（15.6个月）。总之，（1）当单纯全身溶栓失败时，经皮腔内静脉血管成形术是一种有价值的辅助治疗方法；（2）由于药物因素保持不变，节段性血流和机械性梗阻是关键因素；（3）更积极的递增介入策略值得考虑。
