| Objective: Lower extremity deep vein thrombosis(DVT)is a common clinical disease,vascular surgery affects of different ages,the part of the can develop in patients with pulmonary embolism(PE)and post-thrombosis syndrome(PTS),severe cases can be disabling or even life-threatening,brings to the society,the family burden and pain。In the United States,the incidence of deep venous thrombosis is about 1/1000 per year,and about one-third of untreated symptomatic patients are combined with PE,which is second only to tumor and myocardial infarction,about 15%.Now think venous blood stasis,vein wall damage and high blood coagulation state for the pathogenic factors,interaction to platelet accumulation increased,a large number of white blood cells and red blood cell aggregation,eventually for venous thrombosis.The main symptoms are different,which is related to the blood clots,the extent of thrombosis,the degree of obstruction of the venous tube and the collateral circulation,and the swelling and the pain of the body.The treatment of deep vein thrombosis,including anticoagulation,thrombolysis,percutaneous mechanical embolus removal,etc.,for acute lower extremity deep vein thrombosis cavity treatment technology and standard anticoagulant therapy has obtained the good effect and reduce long-term complications,but in our country,because of various reasons some acute stage in patients with treatment,did not see a doctor and have not been system into the subacute stage(onset time 15-30 d)later,thrombosis for mixed thrombosis,pulmonary embolism,thrombosis and vascular wall adhesion gradually close,part of the machine,and venous valve adhesion damage,causing poor treatment effect,lead to the limb dysfunction,some can lead to limb ischemia,necrosis,serious impact on people’s lives,increase social intervention cost,and the demands of patients hospitalized,effect in the treatment of subacute phase of deep vein thrombosis is a vascular surgeon we urgently need to solve the problem.The purpose of this study is to analyze the therapeutic effect of interventional therapy on the treatment of deep venous thrombosis in lower extremity in subacute stage.Methods: This study analyzed the clinical data of 56 patients(56 limbs)subacute lower limb deep venous thrombosis in the Xingtai people’s hospital from January 2014 to January 2017.The inclusion criteria:1.First onset.2.Medical history is more than 14 days.3.Both the central or mixed lower extremity venous thrombosis were confirmed by B type ultrasound or lower extremity venous angiography.4.Plasma D dimer increases.5.No anticoag-ulation and thrombolytic taboo.6.Limb swelling,patellar edge on limb 15 cm thigh circumference is larger than the contralateral 3-7 cm.7.No serious heart,lung and brain dysfunction,is expected to survive for a long time.The patients’ willingness to choose treatment was divided into control group(group A n= 26)and experimental group(group B=30),and the hospital day was 10-14 days.All of the patients during hospitalization were in bed,raise the limb 15-30.Every 2 days testing measurement of double lower limbs in patients with patellar 15 cm margin on the thigh and under the edge of patellar 15 cm crus limb circumference changes.The normal saline was added to the xuesaitong 0.4g intravenous drip and Low molecular weight heparin calcium 4100 IU subcutaneous injection Q12 h.control group:The limb dorsalis pedis venous trace injection pump pumping urokinase(60-90)million units per day,7 days after stop thrombolysis,anticoagulation with warfarin,international standardization ratio(INR)control around 2.5,patients after discharge law of oral warfarin anticoagulation and wear medical stretch hose for six months.experimental group:Interventional therapy The contralateral limb iliac vein and inferior vena cava unobstructed,puncture angiography showed inferior vena filter smoothly implanted below the renal vein openings,lateral femoral vein puncture and with lateral popliteal vein puncture under ultrasound guidance place choice according to the intraoperative situation after sheath pipe duct suction line thrombosis or balloon dilatation,near heart cathete-rization thrombosis after thrombolysis,trace pump into the urokinase thrombolysis pipe joint(60-90)million units per day,total thrombolysis,7 days after urethral catheter thrombolysis combined with warfarin,INR control with the control group.During observation patient’s symptoms,complications and detecting blood clotting series,every 2 days to give patients after thrombolysis catheter angiography examination,evaluation of therapeutic effect and adjust the position,after 7 days patients on the basis of imaging condition,some patients iliac vein compression syndrome or the residual stenosis of >50%,iliac vein stent placement.Results:1.The swelling rate:To measure the patient’s admission and discharge of the knee joint above and below the knee joint,the rate of swelling was calculated and compared。Before treatment of group A,the circumference difference between the above knee joints and the knee joint was(4.91± 0.69)and(4.52±0.81).Posttreatment circumference difference(2.31±0.48).(1.38±0.39),the swelling rate was(37.43±8.96)%,(54.70±5.44)%,Group B patients before treatment,circumference(4.83±1.15),(3.97±0.63),after treatment,the perimeter difference(1.21±0.46),(0.71±1.12),the swelling rate(71.21±9.24)%.(80.97±6.50)%after statistics analysis,there is significant difference(P<0.05),the experimental group was better than control group,especially knee swelling effect。2.Thrombolytic rate:After thrombolysis treatment,thrombolysis rate of group A(43.98 ± 4.62)%,thrombolytic rate of group B(65.34 ± 5.87)%,two methods of treatment of thrombolysis have significant difference(P<0.05).3.Thrombosis rate:Follow-up of 6 months was followed by 5 cases of thrombosis in group A.In group B,1 case of thrombosis occurred in patients with thromboembolism.In group A,the recurrence rate was 19.2%,and the group B was 3.3%,The positive treatment of the bone iliac vein thrombosis reflected,the blood flow to the recovery was significantly reduced.4.After the follow-up of 6 months,Villalta score was given to patients group A score(4.73 ± 0.72)and group B(3.25 ± 0.81).The rate of Villalta score 5 and above or the lower limb is ulcerated was defined as PTS.The incidence rate of PTS A and B were 10% and 23.07% respectively,and P<0.05 was statistically significant.The difference between the two treatments.Conclusions:1.Subacute phase of lower extremity deep vein thrombosis should attach importance to and have actively treatment,local contact of transcatheter thrombolysis treatment of subacute phase of vein thrombosis more limb dorsalis pedis intravenous thrombolysis can play a role in thrombolysis,and low bleeding risk,improve the vein patency rate at the same time further reduce in the PTS,relieve the clinical symptoms,it is a safe and effective treatment.2.In catheter thrombolysis as adjuvant therapy on the basis of the joint duct suction bolt,balloon dilatation and stent intracavitary interventional techniques,can increase the venous thrombus take rate,improve the long-term patency rate. |
PDF Full Text Request