대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제64권3호
  • /
  • Pages.231-238
  • /
  • 2011
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

급성하지정맥혈전증에서 유도카테터를 이용한 흡입제거술: 종아리 압박술의 유용성

Aspiration Thrombectomy Using a Guiding Catheter in Acute Lower Extremity Deep Vein Thrombosis: Usefulness of the Calf-Squeeze Technique

  • 이재아 (전북대학교 의학전문대학원 영상의학과) ;
  • 곽효성 (전북대학교 의학전문대학원 영상의학과) ;
  • 한영민 (전북대학교 의학전문대학원 영상의학과) ;
  • 유희철 (전북대학교 의학전문대학원 외과)
  • Lee, Jae-A (Department of Radiology, Chonbuk National University Medical School) ;
  • Kwak, Hyo-Sung (Department of Radiology, Chonbuk National University Medical School) ;
  • Han, Young-Min (Department of Radiology, Chonbuk National University Medical School) ;
  • Yu, Hee-Chul (Department of Surgery, Chonbuk National University Medical School)
  • 발행 : 2011.03.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 급성 하지 심부정맥혈전증 환자의 치료에서 유도카테터-흡인혈전제거술시 장딴지 압박술의 효과에 대해 알아보고자 하였다. 대상과 방법: 엉덩정맥의 폐쇄와 동측의 심부정맥혈전증이 있는 환자 10명을 대상으로 전향적 분석을 시행하였다. 모든 환자는 하지부종과 통증을 호소하였으며 하대정맥 필터를 삽입 후 동측 슬와 정맥을 통한 카테터-혈전용해술로 치료하였다. 그 다음에 유도카테터를 이용한 흡인혈전제거술로 남아 있는 혈전을 제거하였다. 장딴지 압박술은 흡인혈전제거술을 하는 동안 오금정맥, 정강정맥, 근육 내 정맥의 혈전의 근위부로의 이동을 유도하고, 정맥혈류를 증가시키기 위해 사용하였다. 결과: 평균 장딴지 압박술을 한 횟수는 1.3회(1-3)였다. 모든 환자에서 장딴지 압박술을 하는 동안 오금정맥과 근육내 정맥의 혈전이 근위부로 이동하는 것을 볼 수 있었다. 모든 환자에서 성공적인 재개통을 보였으며 합병증은 없었다. 흡인혈전제거술 후 즉시 시행한 도플러 초음파에서 4명의 환자에서 가자미근내 정맥에 남아 있는 혈전이 있었다. 그러나 슬와정맥과 경골정맥에 혈전이 남아 있는 환자는 없었다. 추적관찰 기간 동안 심부정맥혈전증의 재발은 없었다. 결론: 카테터-직접 혈전용해술 후 흡인혈전제거술을 하는 동안 장딴지 압박술을 이용하는 것은 슬와정맥과 근육 내정맥의 혈전의 근위부 이동을 유도하며 장딴지 정맥 혈전 제거의 효과적인 방법이다.

Purpose: The effectiveness of the calf-squeeze technique during aspiration thrombectomy using guiding catheter in the treatment of an acute lower extremity deep vein thrombosis (DVT) was evaluated by the use of imaging and the clinical follow-up of patients. Materials and Methods: A prospective analysis of ten patients (seven women, three men; median age, 56.9 years) with common iliac vein (CIV) obstruction and ipsilateral DVT was performed for this study. All patients presented with leg edema or pain and were treated with catheter-directed thrombolysis via an ipsilateral popliteal vein approach after insertion of a temporary inferior vena cava (IVC) filter. Subsequently, the patients were treated with by aspiration thrombectomy using a guiding catheter to remove the residual thrombus. The calf-squeeze technique during aspiration thrombectomy can be used to induce the proximal migration of thrombi in the popliteal, tibial, and muscular veins were used to increase venous flow. Results: The calf-squeeze technique was employed at mean of 1.3 times (range, 1-3 times). All patients showed proximal migration of a popliteal and muscular vein thrombus during the execution of the calf-squeeze technique. Successful recanalization was achieved in all patients (100%) without any complications. On duplex ultrasonography, which was performed immediately after the aspiration thrombectomy, four patients had a residual thrombus in the soleal muscular veins. However, none of the patients had a thrombus in the popliteal and tibial veins; and, during follow-up, no DVT recurred in any patient. Conclusion: The use of the calf-squeeze technique during aspiration thrombectomy after catheter-directed thrombolysis can induce the proximal migration of thrombi in the popliotibial and muscular veins and is an effective method that can remove a thrombus in calf veins.

키워드

참고문헌

  1. Markel A, Manzo RA, Bergelin RO, Strandness DE Jr. Valvular reflux after deep vein thrombosis: incidence and time occurrence. J Vasc Surg 1992;15:377-384 https://doi.org/10.1016/0741-5214(92)90259-B
  2. Akessoon H, Brudin L, Dahlstom JA, Eklof B, Ohlin P, Plate G. Venous function assessed during a 5 year period after cute iliofemoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg 1990;4:43-48 https://doi.org/10.1016/S0950-821X(05)80037-4
  3. Comerota AJ, Aldridge SC, Cohen G, Ball DS, Pliskin M, White JV. A strategy of aggressive regional therapy for acute iliofemoral venous thrombosis with contemporary venous thrombectomy or cateter-directed thrombolysis. J Vasc Surg 1994;20:244-254 https://doi.org/10.1016/0741-5214(94)90012-4
  4. Semb CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology 1994; 191:487-494 https://doi.org/10.1148/radiology.191.2.8153327
  5. O'Sullivan GJ, Semba CP, Bittner CA, Kee ST, Razavi MK, Sze DY, et al. Endovascular management of iliac vein compression (May- Thurner) syndrome. J Vasc Interv Radiol 2000;11:823-826 https://doi.org/10.1016/S1051-0443(07)61796-5
  6. Kwak HS, Han YM, Lee YS, Jin GY, Chung GH. Stents in common iliac vein obstruction with acute ipsilateral deep vein thrombosis: early and late results. J Vasc Interv Radiol 2005;16:815-822 https://doi.org/10.1097/01.RVI.0000157690.91690.38
  7. Patel NH, Stookey KR, Ketcham DB, Cragg AH. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol 2000; 11:1297-1302 https://doi.org/10.1016/S1051-0443(07)61304-9
  8. Vedantham S, Vesely TM, Sicard GA, Brown D, Rubin B, Sanchez LA, et al. Pharmacomechanical thrombolysis and early stent placement for iliofemoral deep vein thrombosis. J Vasc Interv Radiol 2004;15:565-574 https://doi.org/10.1097/01.RVI.0000127894.00553.02
  9. Kim HS, Patra A, Paxton BE, Khan J, Streiff M. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol 2006;17:1099-1104 https://doi.org/10.1097/01.RVI.0000228334.47073.C4
  10. Kasirajan K, Gray B, Ouriel K. Percutaneous angioJet thrombectomy in the management of extensive deep venous thrombosis. J Vasc Interv Radiol 2001;12:179-185 https://doi.org/10.1016/S1051-0443(07)61823-5
  11. Vedantham S, Vesely TM, Parti N, Darcy M, Hovseian DM, Picus D. Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol 2002;13:1001-1008 https://doi.org/10.1016/S1051-0443(07)61864-8
  12. Jaffe JW, Newcomb JA, York T, Matulewicz TJ. Venous valvular assessment after retrograde catheterization. J Vasc Intev Radiol 1996;7:595-597 https://doi.org/10.1016/S1051-0443(96)70811-4
  13. Armon MP, Whitaker SC, Tennant WG. Catheter-directed thrombolysis of iliofemoral deep vein thrombosis. A new approach via the posterior tibial vein. Eur J Endovasc Surg 1997;13:413-416 https://doi.org/10.1016/S1078-5884(97)80086-X
  14. Enden T, Sandvik L, Klow N, Hafsahl G, Holme PA, Holmen LO, et al. Catheter-directed venous thrombolysis in acute iliofemoral vein thrombosis-the CaVenT study: rationale and design of a multicenter, randomized, controlled, clinical trial. Am Heart J 2007;154:808-814 https://doi.org/10.1016/j.ahj.2007.07.010
  15. Lin PH, Zhou W, Dardik A, Mussa F, Kougias P, Hedayati N, et al. Catheter-directed thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg 2006;19:782-788
  16. O'Sullivan G, Lohan DG, Gough N, Cronin CG, Kee ST. Pharmacomechanical thrombectomy of acute deep vein thrombosis with the Trellis-8 isolated thrombolysis catheter. J Vasc Interv Radiol 2007;18:715-724 https://doi.org/10.1016/j.jvir.2007.03.013
  17. Kolbel T, Lindh M, Holst J, Uher P, Eriksson KF, Sonesson B, et al. Extensive acute deep vein thrombosis of the iliocaval segment: midterm results of thrombolysis and stent placement. J Vasc Interv Radiol 2007;18:243-50 https://doi.org/10.1016/j.jvir.2006.12.002
  18. Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in ilofemoral venous thrombosis: a randomized clinical trial. Eur J Vasc Endovasc Surg 2002;24:209-214 https://doi.org/10.1053/ejvs.2002.1665
  19. Watson LI, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Library 2005;1:1-66
  20. Wells PS, Forster AJ. Thrombolysis in deep vein thrombosis: is there still an indication. Thromb Haemost 2001;86:499-508
  21. Mewissen WM, Seabrook GR, Meissner MH, Cynamn J, Labroonlos N, Haughton SH, et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of national multicenter registry. Radiology 1999;211:39-49 https://doi.org/10.1148/radiology.211.1.r99ap4739
  22. McLennan G, Trerotola SO, Davidson E, Rhodes CA, Lazzaro C, Dreesen J, et al. The effects of a mechanical thrombolytic device on normal canine vein valves. J Vasc Interv Radiol 2001;12:89-94 https://doi.org/10.1016/S1051-0443(07)61409-2
  23. Roy S, Laerum F. Transcatheter aspiration: the key to successful percutaneous treatment of deep venous thrombosis? Acad Radiol 1999;6:730-735 https://doi.org/10.1016/S1076-6332(99)80469-3
  24. Sharafuddin MJ, Gu X, Han YM, Urness M, Gunther R, Amplatz K. Injury potential to venous valve from the Amplatz thrombectomy device. J Vasc Interv Radiol 1999;10:64-69 https://doi.org/10.1016/S1051-0443(99)70013-8
  25. Polak JF. Peripheral vascular sonography: a practical guide, 2nd ed. Philadelphia: Lippincott Williams and Wilkins, 2004:168-220