股深静脉血栓清除在急性下肢深静脉血栓形成腔内治疗中的价值

外科理论与实践››2025,Vol. 30››Issue (01): 61-65.doi:10.16139/j.1007-9610.2025.01.11

股深静脉血栓清除在急性下肢深静脉血栓形成腔内治疗中的价值

倪其泓, 陈佳佺, 郭相江, 叶猛, 张岚()

开云网页登录医学院附属仁济医院血管外科，上海 200127

收稿日期:2024-10-21出版日期:2025-01-25发布日期:2025-04-25
通讯作者:张岚，Email：lucky200207@aliyun.com
基金资助:
国家自然科学基金(82370495);仁济医院IIT项目(IIT-2023-0254)

Clinical value of profunda femoral vein thrombosis clearance in endovascular treatment of acute lower extremity deep vein thrombosis

NI Qihong, CHEN Jiaquan, GUO Xiangjiang, YE Meng, ZHANG Lan()

Department of Vascular Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2024-10-21Online:2025-01-25Published:2025-04-25

摘要/Abstract

摘要：

目的：评估股深静脉血栓清除在急性下肢深静脉血栓形成（DVT）腔内治疗中的安全性与有效性。方法：回顾性分析2022年1月至2023年9月于我院对股深静脉血栓行经皮机械血栓清除（PMT）的急性下肢DVT病人临床资料。分析术后12个月的髂股静脉一期通畅率和血栓形成后综合征（PTS）发生率。结果：共22例纳入研究，所有病人均对股深静脉血栓行PMT。其中5例通过对侧股总静脉“翻山”入路，17例通过对侧股总静脉“翻山”联合患侧深静脉入路。术后12个月髂股静脉的一期通畅率为90.9%（20/22），PTS的发生率为9.1%（2/22）。结论：急性下肢DVT行腔内治疗的病人，对股深静脉血栓行PMT治疗安全有效，可获得良好的髂股静脉一期通畅率，且PTS的发生率低。

关键词:股深静脉,急性下肢深静脉血栓形成,经皮机械血栓清除,通畅率,血栓形成后综合征

Abstract:

ObjectiveTo evaluate the safety and efficacy of profunda femoral vein thrombosis clearance in endovascular treatment of acute lowerextremity deep venous thrombosis (DVT).MethodsFrom January 2022 to September 2023, clinical data of acute lowerextremity DVT patients who underwent percutaneous mechanical thrombectomy (PMT) for profunda femoral vein thrombosis were retrospectively analyzed. The 12-month primary patency rate of iliofemoral vein and incidence of post-thrombotic syndrome(PTS) were analyzed.ResultsTwenty-two patients were included in the study, and all patients underwent PMT for profunda femoral vein thrombosis. Five patients were treated through the contralateral common femoral veinviacrossover approach, and 17 patients were treated through the contralateral common femoral vein combined with the ipsilateral deep vein approach. The 12-month primary patency rate of iliofemoral vein was 90.9% (20/22), and the incidence of PTS was 9.1% (2/22).ConclusionsFor patients with acute lowerextremity DVT undergoing endovascular treatment, PMT for profunda femoral vein thrombosis is safe and effective, achieving good primary patency of iliofemoral vein and low incidence of PTS.

Key words:Profunda femoral vein,Acute lower extremity deep vein thrombosis (DVT),Percutaneous mechanical thrombectomy(PMT),Patency,Post-thrombotic syndrome(PTS)

中图分类号:

R543.6

倪其泓, 陈佳佺, 郭相江, 叶猛, 张岚. 股深静脉血栓清除在急性下肢深静脉血栓形成腔内治疗中的价值[J]. 外科理论与实践, 2025, 30(01): 61-65.

NI Qihong, CHEN Jiaquan, GUO Xiangjiang, YE Meng, ZHANG Lan. Clinical value of profunda femoral vein thrombosis clearance in endovascular treatment of acute lower extremity deep vein thrombosis[J]. Journal of Surgery Concepts & Practice, 2025, 30(01): 61-65.

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参考文献16

[1]	KHAN F, TRITSCHLER T, KAHN S R, et al. Venous thromboembolism[J].Lancet,2021,398(10294):64-77. doi:10.1016/S0140-6736(20)32658-1pmid:33984268
[2]	DUFFETT L. Deep venous thrombosis[J].Ann Intern Med,2022,175(9):ITC129-ITC144.
[3]	STEVENS S M, WOLLER S C, BAUMANN KREUZIGER L, et al. Executive summary: antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report[J].Chest,2021,160(6):2247-2259.
[4]	MAZZOLAI L, AGENO W, ALATRI A, et al. Second consensus document on diagnosis and management of acute deep vein thrombosis: updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function[J].Eur J Prev Cardiol,2022,29(8):1248-1263.
[5]	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,9(4):250-257.
	Vascular Surgery Group, Chinese Society of Surgery, Chinese Medical Association. Guidelines for the diagnosis and treatment of deep vein thrombosis (third edition)[J].Chin J Gen Surg,2017,9(4):250-257.
[6]	倪其泓, 郭相江, 杨硕菲, 等. 小腿深静脉入路经皮机械血栓清除治疗全下肢型急性深静脉血栓形成的安全性及疗效分析[J].中华医学杂志,2022,102(7):486-490.
	NI Q H, GUO X J, YANG S F, et al. Safety and efficacy of percutaneous mechanical thrombectomy through ipsilateral calf venous access in the treatment of entire-limb acute deep venous thrombosis[J].Natl Med J China,2022,102(7):486-490.
[7]	ATTARAN R R, OZDEMIR D, LIN I H, et al. Evaluation of anticoagulant and antiplatelet therapy after iliocaval stenting: factors associated with stent occlusion[J].J Vasc Surg Venous Lymphat Disord,2019,7(4):527-534. doi:S2213-333X(19)30151-9pmid:31203859
[8]	NI Q, ZHAO Y, XUE G, et al. Directional femoral ultrasound-guided compression technique using in percuta-neous mechanical thrombectomy for acute deep vein thrombosis: a retrospective cohort study[J].J Endovasc Ther,2024,26:15266028241266223.
[9]	倪其泓, 薛冠华, 郭相江, 等. AngioJet改进入路治疗全下肢型急性深静脉血栓形成[J].中华普通外科杂志,2020,35(4):304-308.
	NI Q H, XUE G H, GUO X J, et al. Modified approach improves the clinical efficacy of AngioJet in treatment of whole-lower-limb acute deep vein thrombosis[J].Chin J Gen Surg,2020,35(4):304-308.
[10]	NI Q, LONG J, GUO X, et al. Clinical efficacy of one-stage thrombus removalviacontralateral femoral and ipsilateral tibial venous access for pharmacomechanical thrombectomy in entire-limb acute deep vein thrombosis[J].J Vasc Surg Venous Lymphat Disord,2021,9(5):1128-1135.
[11]	MAKEDONOV I, KAHN S R, GALANAUD J P. Prevention and management of the post-thrombotic syndrome[J].J Clin Med,2020,9(4):923.
[12]	张福先. 静脉血栓栓塞症诊治的最新关注[J].外科理论与实践,2019,24(4):293-296.
	ZHANG F X. The latest attention on the diagnosis and treatment of venous thromboembolism[J].J Surg Concepts Pract,2019,24(4):293-296.
[13]	VEDANTHAM S, GOLDHABER S Z, JULIAN J A, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis[J].N Engl J Med,2017,377(23):2240-2252.
[14]	张涛, 吴书圣, 秦士勇, 等. 股深动脉血运重建治疗下肢缺血的应用现状[J].中华普通外科杂志,2022,37(1):74-77.
	ZHANG T, WU S S, QIN S Y, et al. Application status of deep femoral artery revascularization in the treatment of lower limb ischemia[J].Chin J Gen Surg,2022,37(1):74-77.
[15]	BROHOLM R, BÆKGAARD N, HANSEN S, et al. Significance of partial or complete thrombosis of the common and deep femoral vein in patients with deep vein thrombosis[J].Eur J Vasc Endovasc Surg,2019,58(4):570-575.
[16]	QAMHAWI Z, KEARNS D, WILTON E, et al. Thrombectomy of the profunda femoral vein in iliofemoral deep venous thrombosis using an antegrade popliteal approach[J].Cardiovasc Intervent Radiol,2024,47(3):379-385.