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目的 探讨应用双股静脉入路技术 ,治疗髂 -股静脉血栓 (I -FVT)的有效性。方法 下肢深静脉顺行造影证实为I -FVT患者 18例。经健侧股静脉置入下腔静脉滤器 ,然后经健侧股静脉置管于患侧髂静脉入下腔静脉处造影。导丝导管无法进入患侧髂 -股静脉者 ,行患侧股静脉穿刺插管 ,顺行开通股 -髂静脉至下腔静脉内。随后再经健侧插管至患侧开通段内 ,并继续开通下方的闭塞段。对开通段用球囊导管顺次扩张、拖拉 ;对闭塞段中较松软的血栓应用血栓消融器 (ATD)或溶栓导管 (OASIS)进行消融或抽吸术 ;术后保留导管 1～ 6d ,持续行接触性溶栓与抗凝治疗 ,撤管后继续行严格抗凝、溶栓治疗。结果 18例经双股静脉入路治疗者 ,15例取得明显的疗效 ,表现为患肢肿胀迅速消退 ,疼痛消失 ,肢体松软 ,活动恢复正常 ;另外 2例开通后 ,患肢肿胀减轻 ,好转出院 ;1例未能开通 ,经同侧足背静脉静滴抗凝、溶栓药物 ,症状好转出院。全部病例均未发生肺梗死。术后随访 3～ 39个月 ,平均 16.4个月 ,无症状性复发。结论 双股静脉入路治疗I -FVT ,是一种较为简便、安全、有效的方法
Objective To investigate the effectiveness of dual femoral vein approach for the treatment of iliac-femoral vein thrombosis (I -FVT). Methods 18 cases of I -FVT were confirmed by paracentesis of lower extremity. The contralateral femoral vein into the inferior vena cava filter, and then contralateral femoral vein cannulation in the ipsilateral iliac vein into the inferior vena cava at the contrast. Guide wire catheter can not enter the ipsilateral iliac - femoral vein, the line of ipsilateral femoral vein puncture intubation, cis open shares - iliac vein to the inferior vena cava. Then by the contralateral intubation to the ipsilateral opening paragraph, and continue to open the lower occlusion. On the open section of the balloon catheter in order to expand, drag; on the occlusion of the more soft thrombus using thrombus ablator (ATD) or thrombolytic catheter (OASIS) for ablation or aspiration; postoperative catheter 1 ~ 6d, Continuous line of contact with thrombolysis and anticoagulant therapy, followed by strict anticoagulation and thrombolytic therapy after withdrawal. Results Eighteen patients treated by dual-femoral vein had obvious curative effect in 15 cases. The swelling of the affected limb quickly subsided, the pain disappeared, the limbs were soft, and the activity returned to normal. In the other two cases, the limb swelling was relieved and was discharged ; 1 case failed to open, the ipsilateral dorsal vein intravenous infusion of anticoagulants, thrombolytic drugs, symptoms improved discharge. No pulmonary infarction occurred in all cases. The patients were followed up for 3 to 39 months, with an average of 16.4 months, with asymptomatic recurrence. Conclusions Dual-venous access is a simple, safe and effective method for the treatment of I -FVT