The Clinical Analysis Of The Diagnosis And Treatment In Deep Vein Thrombosis Of Lower Limb Complicating Pulmonary Embolism

Objective To evaluate the diagnosis and treatment in deep vein thrombosis oflower limb complicating pulmonary embolism.Methods To analyze the clinical data of45cases （49limbs） of DVTcomplicating with PTE being treated in vascular surgery of our hospital from Januaryof2011to December of2012.All cases were diagnosed by deep venous color doplorflow image (CDFI) or deep venous angiography in the lower extremity DVT,and PTEwas diagnosed by computer tomography pulmonary angiography (CTPA).Includingthe anticoagulation+popliteal vein catheter thrombolytic therapy in29patients (30limbs), anticoagulation+system thrombolytic therapy in6patients (8limbs),anticoagulant therapy only in10patients (11limbs).Results The45cases of DVT complicating with PTE, including21males,24females, aged25-83years, average59.71±14.16years.Majority of patients aged over40-year-old, accounts for93.3%. Majority of patients（97.8%） had risk factors，ofwhich Left iliac vein compression syndrome, surgery, trauma were the mainpathogenic factors.The main symptoms of PTE were cough, dyspnea, chest tightness,fever, while the triad of pulmonary infarction was less(8.8%).The CTPA wereperformanced of varying degrees of angiography defects in the pulmonary vascular,which were more common in bilateral pulmonary,and the right than the left.Theincidence of PTE was higher in patients with a right-side DVT (87.5%) than inpatients with a left-side DVT (39.1%).There was no significant difference clinicaleffective rate between the group receiving only anticoagulation therapy(80.0%,) andgroups receiving catheter thrombolysis and system thrombolytic therapy(94.3%).Theshort-term effect of popliteal vein thrombolysis treatment was satisfactory in DVT inlimb swelling rate and vein patency rate.We placed inferior vena cava filter(VCF) tosuccessfully block off blood clots in6of41cases, none of them recurrenced of severePTE.9cases retained VCF were followed up for3-28months (mean11.71±5.72months), none of them recurrenced asymptomatic PTE, no stent migration, deformation, perforation.Conclusion Many acquired factors may lead to VTE, which left iliac veincompression syndrome, surgery, trauma as the main pathogenic factors. The embolifrom the DVT may cause high incidence of PTE, especially the patients withright-side DVT.The PTE patients are lack of specific clinical symptoms, who areespecially missed diagnosis, while the CTPA can be used as the primary inspectionmethod for the diagnosis of PTE. With timely diagnosis and treatment, the majority ofVTE patients through anticoagulant and thrombolytic treatment can achievesatisfactory efficacy. The short-term effect of catheter thrombolytic treatment issatisfactory in DVT patients,while anticoagulant treatment can also achievesatisfactory clinical efficacy, but for large area of PTE patients,we recommend to useof thrombolytic therapy.The placement of VCF can block off blood clots to decreasethe PTE and reduce mortality.