李桂潘,罗世官

肺栓塞（pulmonary embolism，PE）合并急性下肢深静脉血栓（Acute Deep Vein Thrombosis，ADVT）是一种严重的血栓栓塞性疾病，具有较高的发病率和死亡率，传统抗凝治疗效果有限。导管内溶栓（catheter-directed thrombolysis，CDT）技术的出现，通过将溶栓导管直接置入血栓所在血管，局部灌注溶栓药物，显著提高了血栓清除效率，同时大幅降低了所需药物剂量和系统性出血风险，改善了患者预后。

肺栓塞；导管内溶栓；下肢深静脉血栓；介入治疗

[1] 中华医学会心血管病学分会,中国医师协会心血管内科医师分会肺血管疾病学组,中国肺栓塞救治团队(PERT)联盟.急性肺栓塞多学科团队救治中国专家共识[J].中华心血管病杂志,2022,50(1):25-35. [2] Olin JW.Pulmonary embolism[J].Rev Cardiovasc Med,2002,3(Suppl 2):S68-75. [3] Konstantinides SV,Meyer G,Becattini C,et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society(ERS):The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology(ESC)[J].Eur Heart J,2020,41(4):543-603. [4] 中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南[J].中华医学杂志,2018,98(14):1060-1087. [5] Charif F,Khatoun H,Nassar P,et al.Low dose peripheral systemic thrombolysis for treatment of intermediate-high risk acute pulmonary embolism:A case series[J].Eur Heart J,2022,6(10):417. [6] Halaby R,Giri J.Keep it simple?Half-dose systemic thrombolysis or catheter-directed thrombolysis for pulmonary embolism[J].Vasc Med,2019,24(2):110-111. [7] Piazza G,Hohlfelder B,Jaff MR,et al.A prospective,single-arm,multicenter trial of ultrasound-facilitated,catheter-directed,low-dose fibrinolysis for acute massive and submassive pulmonary embolism:The SEATTLE II study[J].JACC Cardiovasc Interv,2015,8(10):1382-1392. [8] Engelhardt TC,Taylor AJ,Simprini LA,et al.Catheter-directed ultrasound-accelerated thrombolysis for the treatment of acute pulmonary embolism[J].Thromb Res,2011,128(2):149-154. [9] Harvey JJ,Huang S,Uberoi R.Catheter-directed therapies for the treatment of high risk(massive)and intermediate risk(submassive)acute pulmonary embolism[J].Cochrane Database Syst Rev,2022,8(8):CD013083. [10] Gautier G,Douane F,David A,et al.Pharmaco-mechanical catheter-directed thrombolysis versus recanalization and stenting for post thrombotic syndrome after lower limb deep vein thrombosis:a comparative study[J].Quant Imaging Med Surg,2022,12(3):1664-1673. [11] Khalid MU,Singh M,Lakhter V,Bashir R.Catheter directed thrombolysis for deep vein thrombosis in 2022:Rationale,evidence base and future directions[J].Int J Cardiol,2022,362:168-173. [12] 韩丽珠,尹琪楠,边原,等.深静脉血栓和肺栓塞的管理与治疗:对美国血液病学会静脉血栓栓塞管理指南的解读[J].中国新药与临床杂志,2021,40(11):784-788. [13] Vedantham S,Salter A,Lancia S,et al.Clinical Outcomes of a Pharmacomechanical Catheter-Directed Venous Thrombolysis Strategy that Included Rheolytic Thrombectomy in a Multicenter Randomized Trial[J].J Vasc Interv Radiol,2021,32(9):1296-1309.e7. [14] Enden T,Haig Y,Kløw NE,et al.Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis(the CaVenT study):a randomised controlled trial[J].Lancet,2012,379(9810):31-38. [15] Alhazmi L,Moustafa A,Mangi MA,et al.Efficacy and Safety of Catheter-directed Thrombolysis in Preventing Post-thrombotic Syndrome:A Meta-analysis[J].Cureus,2019,11(2):e4152. [16] Kim YA,Yang SS,Yun WS.Does Catheter-Directed Thrombolysis Prevent Postthrombotic Syndrome?[J].Vasc Specialist Int,2018,34(2):26-30. [17] Kuo TT,Huang CY,Hsu CP,et al.Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis[J].J Chin Med Assoc,2017,80(2):72-79. [18] 李晓强,张福先,王深明.深静脉血栓形成的诊断和治疗指南(第三版)[J].中国血管外科杂志(电子版),2017,9(4):250-257. [19] Blankstein R,Gulati M,Jaber WA,et al.The 2021 chest pain guideline[J].JACC Cardiovasc Imaging,2021,14(11):2079-2080. [20] Konstantinides SV,Meyer G,Becattini C,et al.2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism Developed in Collaboration with the European Respiratory Society(ERS)[J].Eur Respir J,2019,54(3):1901647. [21] Giordano NJ,Jansson PS,Young MN,et al.Epidemiology,pathophysiology,stratification,and natural history of pulmonary embolism[J]. Tech Vasc Interv Radiol,2017,20(3):135-140. [22] 陈东海,陈鑫遥,蔡彦,等.肺栓塞合并下肢深静脉血栓患者的临床特征分析[J].临床急诊杂志,2022,23(5):305-309. [23] 李晓强,张福先,王深明.深静脉血栓形成的诊断和治疗指南(第三版)[J].中国血管外科杂志(电子版),2017,9(4):250-257. [24] Huang T,Ding W,Chen Z,et al.Comparison of pharmacomechanical catheter-directed thrombolysis versus catheter-directed thrombolysis for the treatment of acute iliofemoral deep vein thrombosis:measures of long-term clinical outcome and quality of life[J].Ann Vasc Surg,2021,76:436-442. [25] 党永康,杨柳,姜学超,等.经胫后静脉入路置管溶栓术治疗急性下肢深静脉血栓形成的临床研究[J].中国血管外科杂志(电子版),2021,9(4):262-265. [26] 张明照,卢冉,向军益,等.经皮穿刺胫后静脉入路治疗急性混合型单侧下肢深静脉血栓形成的疗效[J].中华全科医学,2022, 20(4):560-564. [27] 赵得银,于智勇,张艮龙,等.不同置管入路溶栓治疗急性下肢深静脉血栓形成的应用效果[J].实用医学杂志,2020,36(16):2269-2272. [28] Vedantham S,Desai KR,Weinberg I,et al.Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis[J].J Vasc Interv Radiol,2023,34:284.e7-299.e7. [29] Chen X,Luo Q,Xu W,et al.Comparative study of two different access points,one tibial vein and the popliteal vein,for catheter-directed thrombolysis in the treatment of acute mixed lower extremity deep vein thrombosis[J].Ann Vasc Surg,2024,110:110-119. [30] Wang H,Qi X,Chen Y,et al.A Retrospective study comparing 2 approaches to catheter-directed thrombolysis for acute deep venous thrombosis[J].Ann Vasc Surg,2018,50:30-37. [31] Yang B,Xu XD,Gao P,et al.Catheter-Directed Thrombolysis via Small Saphenous Veins for Treating Acute Deep Venous Thrombosis[J]. Med Sci Monit,2016,22:2972-2980. [32] Lazaar S,Mazaud A,Delsuc C,et al.Ultrasound guidance for urgent arterial and venous catheterisation:randomised controlled study[J]. Br J Anaesth,2021,127(6):871-878. [33] Liu G,Liu X,Wang R,et al.Catheter-Directed Thrombolysis of Acute Entire Limb Deep Vein Thrombosis From below the Knee Access:A Retrospective Analysis of a Single-Center Experience[J].Catheter Cardiovasc Interv,2018,91(2):310-317. [34] Bendix SD,Nolan R,Banipal S,et al.Posterior tibial vein approach to catheter-directed thrombolysis for iliofemoral deep venous thrombosis[J].J Vasc Surg Venous Lymphat Disord,2019,7(5):629-634. [35] Yi KH,Lee JJ,Hur HW,et al.Anatomical consideration of deep calf veins:application to catheter-directed thrombolysis[J].Surg Radiol Anat,2021,43(12):2071-2076. [36] Wang H,Qi X,Luo H,et al.Catheter-directed thrombolysis through anterior tibial vein for treating acute extensive deep venous thrombosis[J].J Vasc Surg Venous Lymphat Disord,2018,6(6):681-688. [37] Montes MC,Carbonell JP,Gómez-Mesa JE.Endovascular and medical therapy of May-Thurner syndrome:Case series and scoping literature review[J].J Med Vasc,2021,46(2):80-89. [38] Radaideh Q,Patel NM,Shammas NW.Iliac vein compression:epidemiology,diagnosis and treatment[J].Vasc Health Risk Manag,2019, 15:115-122. [39] Taha MAH,Busuttil A,Bootun R,et al.A clinical guide to deep venous stenting for chronic iliofemoral venous obstruction[J].J Vasc Surg Venous Lymphat Disord,2022,10(1):258-266.e1. [40] Jayaraj A,Fuller R,Raju S,et al.In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction [J].J Vasc Surg Venous Lymphat Disord,2022,10(1):42-51. [41] Abou Ali AN,Avgerinos ED,Chaer RA.Role of Venous Stenting for Iliofemoral and Vena Cava Venous Obstruction[J].Surg Clin North Am,2018,98(2):361-371. [42] Jiang C,Zhao Y,Wang X,et al.Midterm outcome of pharmacomechanical catheter-directed thrombolysis combined with stenting for treatment of iliac vein compression syndrome with acute iliofemoral deep venous thrombosis[J].J Vasc Surg Venous Lymphat Disord,2020, 8(1):24-30. [43] Wik HS,Enden TR,Ghanima W,et al.Diagnostic scales for the post-thrombotic syndrome[J].Thromb Res,2018,164:110-115. [44] Strijkers RH,Wittens CH,Kahn SR.Villalta scale:goals and limitations[J].Phlebology,2012,27(Suppl 1):130-135. [45] Decousus H,Leizorovicz A,Parent F,et al.A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis[J].N Engl J Med,1998,338(7):409-415. [46] Lattimer CR,Azzam M,Kalodiki E,et al.Compression stockings significantly improve hemodynamic performance in post-thrombotic syndrome irrespective of class or length[J].J Vasc Surg,2013,58(1):158-165. [47] Amin EE,Ten Cate-Hoek AJ,Bouman AC,et al.Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome:a cost-effectiveness analysis[J].Lancet Haematol,2018,5(11):e512-e519.

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