Angle J F, Matsumoto A H, Al Shammari M, Hagspiel K D, Spinosa D J, Humphries J E
University of Virginia, Health Sciences Center, Charlottesville 22908, USA.
J Vasc Interv Radiol. 1998 Nov-Dec;9(6):917-25. doi: 10.1016/s1051-0443(98)70422-1.
To study the efficacy of local infusion of urokinase (UK) in the treatment of symptomatic inferior vena cava (IVC) thrombosis.
Eight patients (five men and three women) who ranged in age from 19 years to 75 years (mean, 56 years) with symptomatic IVC thrombosis underwent local catheter-directed infusion of UK with use of up to three access sites. Infrarenal IVC thrombus and iliac vein thrombus was identified in all patients. Four patients had extension of thrombus proximal to the renal veins. Seven of eight patients had at least one risk factor for IVC thrombosis: hypercoagulable state (n = 3), IVC filter (n = 3), malignancy (n = 2), recent surgery (n = 2), and oral contraceptive use (n = 1). No serious procedure-related complications were encountered, although one patient died 5 days after UK therapy of pulmonary failure due to advanced lung cancer. UK was infused for an average of 79 hours (range, 24-140 hours) and a mean total dose of 7.4 million U of UK (range, 2.9-14.4 million U). Adjunctive balloon angioplasty was performed in three patients. No vascular stents were placed. Clinical and/or radiographic follow-up was obtained in all eight patients.
Thrombolysis was successful in seven of eight (88%) IVCs with no or minimal residual thrombus. The remaining seven patients had no lower extremity swelling 2-24 months (mean, 11 months) after the procedure. Three of seven patients had computed tomographic or venographic follow-up (mean, 9 months; range, 1.5-15 months), demonstrating unchanged or improved IVC patency.
Transcatheter regional infusion of UK for re-establishing venous patency in acute IVC thrombosis appears to be effective with good short-term and mid-term clinical benefit.
研究局部注射尿激酶（UK）治疗有症状的下腔静脉（IVC）血栓形成的疗效。
8例年龄在19岁至75岁（平均56岁）之间、有症状的IVC血栓形成患者接受了局部导管定向注射UK治疗，最多使用3个穿刺部位。所有患者均发现肾下IVC血栓和髂静脉血栓。4例患者血栓延伸至肾静脉近端。8例患者中有7例至少有一项IVC血栓形成的危险因素：高凝状态（n = 3）、IVC滤器（n = 3）、恶性肿瘤（n = 2）、近期手术（n = 2）和口服避孕药（n = 1）。尽管有1例患者在UK治疗5天后因晚期肺癌导致呼吸衰竭死亡，但未出现严重的与操作相关的并发症。UK平均输注79小时（范围为24 - 140小时），UK平均总剂量为740万单位（范围为290万 - 1440万单位）。3例患者接受了辅助球囊血管成形术。未放置血管支架。对所有8例患者进行了临床和/或影像学随访。
8例IVC中有7例（88%）溶栓成功，无残留血栓或残留血栓极少。其余7例患者在术后2 - 24个月（平均11个月）下肢无肿胀。7例患者中有3例进行了计算机断层扫描或静脉造影随访（平均9个月；范围为1.5 - 15个月），显示IVC通畅情况未改变或有所改善。
经导管局部输注UK以重建急性IVC血栓形成时的静脉通畅，似乎是有效的，具有良好的短期和中期临床效益。
