Interventional treatment of lower extremity deep vein thrombosis

  Lower extremity deep vein thrombosis is a common disease, mostly seen in postpartum, post-pelvic surgery, trauma, advanced cancer, coma or long-term bedridden patients, refers to the formation of thrombosis in the veins of the lower extremities, resulting in obstruction of blood return, lower extremity swelling, pain and other clinical symptoms, traditional conservative treatment including peripheral venous route thrombolysis, anticoagulation and surgical embolization treatment is not effective, often leaving the lower extremity deep vein obstruction or venous valve insufficiency It may be followed by lower limb edema, secondary varicose veins, dermatitis, hyperpigmentation, and depressed ulcers. Pulmonary embolism may occur in a few patients due to thrombus dislodgement, which is a common cause of sudden death. It has attracted extensive attention from scholars at home and abroad. Interventional treatment such as lower vena cava filter placement, local thrombolysis, transcatheter thrombus aspiration and lower extremity deep vein endoplasty has provided a broad prospect for the treatment of this disease. The main function is to prevent the thrombus from dislodging in the affected limb and the embolus from going up the blood flow and causing the embolism of important organs. It is indicated in cases where anticoagulation is contraindicated, in people who have failed anticoagulation and have recurrent pulmonary embolism, in chronic pulmonary hypertension, in elderly people with recurrent thrombosis, etc. The placement of an inferior vena cava filter provides a fundamental guarantee against the occurrence of pulmonary embolism in further thrombolytic therapy.  ②Percutaneous catheter contact thrombolysis allows high concentrations of thrombolytic drugs to be instilled directly into the thrombus via the thrombolytic catheter to achieve optimal thrombolytic effect and reduce the incidence of bleeding. For the treatment of acute and non-acute deep vein thrombosis, it has shown better efficacy and has become a common method for the treatment of lower extremity deep vein thrombosis.  ③Transcatheter thrombus aspiration, for thrombosis of longer duration, if thrombolytic therapy cannot completely dissolve the thrombus, transcatheter negative pressure aspiration of thrombus can be further used. It is indicated in cases of loose, free common iliac, external iliac and femoral vein thrombosis.  ④ Iliofemoral vein angioplasty, which is based on the placement of inferior vena cava filter and the use of a combination of local thrombolysis and transcatheter thrombus aspiration, can be used to restore venous blood flow as much as possible and eliminate and improve the clinical symptoms of patients through endovenous angioplasty techniques such as balloon dilation or stent placement. Zhu Jun, Department of Interventional Medicine, Yancheng Third People’s Hospital