下腔静脉滤器术后闭塞合并复杂双下肢静脉血栓的腔内治疗方案：病例报告

doi:10.3969/j.issn.1009-976X.2022.03.016

摘要/Abstract

摘要： 目的滤器引起的下腔静脉闭塞是一种罕见但可以致命的严重并发症,本文目的是报告1例下腔静脉滤器术后闭塞合并左肢体急性血栓形成及右髂静脉慢性血栓形成的诊治。方法患者46岁,男性,因“左大腿进行性胀痛3天”入院,彩超和CT静脉成像（CTV）所示下腔静脉可见金属支架影及下腔静脉、双侧髂总静脉、左侧髂内、外静脉、左侧股静脉、左侧腘静脉、胫前、胫后、腓总静脉广泛血栓形成。随后行腔内治疗手术：经导丝穿刺后置入球囊扩张并在静脉闭塞处植入支架,下腔静脉回流不畅处使用双侧髂外静脉植入球囊对吻扩张后再植入支架。术后常规服用抗凝药至少3个月。结果术后患者腹痛及消化道不适感消失,左大腿肿胀逐渐消失如常。1月及3月常规复查显示下肢深静脉通畅,支架内无血栓形成。结论针对滤器引起的血栓性下腔静脉闭塞以及下肢深静脉血栓的复杂病例,腔内治疗有效及安全。开通双侧髂静脉后的球囊对吻扩张下腔静脉,以及放置支架后球囊扩张,展现了腔内治疗的灵活性,为后续腔内治疗的术式变化以及相应的复杂病例治疗提供了指导作用。

关键词: 下腔静脉滤器闭塞, 静脉血栓, 腔内治疗

Abstract: Objective Filter-induced occlusion of the inferior vena cava is a rare but fatal complication. The aim was to report a case of inferior vena cava filter occlusion complicated with acute thrombosis in the left limb and chronic thrombotic occlusion of the right iliac vein. Methods A 46-year-old male presented to the emergency with the chief complaints of “progressive swelling and pain of the left thigh for 3 days”. Ultrasound and computed tomography venography （CTV） showed metallic stent and multiple thrombosis in inferior vena cava, bilateral common iliac vein, left internal and external iliac vein, left femoral vein, left popliteal vein, anterior tibial, posterior tibial, common peroneal vein. The patient was submitted to endovascular treatment as following：a balloon was placed to dilate and a stent was placed at the vein occlusion site;for the obstruction of inferior vena cava, the stent was implanted after bilateral external iliac vein balloon dilation in a kissing style;for stenosis after stent implantation, balloon dilation was secondly used; the patency of inferior vena cava and external iliac vein was re-evaluated. Anticoagulation was given routinely for at least 3 months. Patient was followed up in first month and third month. Results Postoperative abdominal pain and gastrointestinal discomfort disappeared, and left thigh swelling gradually disappeared as usual. In follow up in first and third month, colorful Doppler ultrasound showed that the deep vein of lower limb was unobstructed and no thrombus was found in the stent. Conclusion For the filter-induced thrombotic inferior vena cava occlusion with acute left lower extremity thrombosis and chronic right iliac vein occlusion, the endovascular treatment was suggestive and proved the effectiveness and safety. Balloon dilation of inferior vena cava in a kissing style and balloon dilation after placing stent showed the flexibility of endovascular treatment, which provided guidance for the endovascular therapy and the treatment of complicated cases.

Key words: inferior vena cava thrombosis, venous thromboembolism, endovascular therapy

中图分类号:

R654.3

彭艳斌, 褚云峰, 陈仲, 郭子睿, 肖颖峰, 周陶. 下腔静脉滤器术后闭塞合并复杂双下肢静脉血栓的腔内治疗方案：病例报告[J]. 岭南现代临床外科, 2022, 22(03): 297-301.

PENG Yan-bin, CHU Yun-feng, CHEN Zhong, GUO Zi-rui, XIAO Ying-feng, ZHOU Tao. Experience in endovascular treatment of filter-induced thrombotic inferior vena cava occlusion with deep venous thrombosis of both lower limbs： case report[J]. Lingnan Modern Clinics In Surgery, 2022, 22(03): 297-301.

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