下腔静脉变异并发下肢深静脉血栓形成的临床诊断及治疗

王辰萌; 余朝文; 聂中林; 卢冉; 官泽宇; 王孝高

doi:10.16766/j.cnki.issn.1674-4152.002445

下腔静脉变异并发下肢深静脉血栓形成的临床诊断及治疗

doi: 10.16766/j.cnki.issn.1674-4152.002445

蚌埠医学院第一附属医院血管外科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究项目 KJ2019A0327

详细信息

通讯作者:
聂中林，E-mail：niezl1988@sina.com

中图分类号: R654.3
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出版历程
- 收稿日期: 2021-12-02
- 网络出版日期: 2022-09-05

Clinical diagnosis and treatment of inferior vena cava variant complicated with lower extremity deep vein thrombosis

Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨先天性下腔静脉变异(inferior vena cava malformation，IVCM)合并下肢深静脉血栓形成(deep vein thrombosis，DVT)的临床诊断与治疗方法。方法回顾性分析2011年8月—2021年7月蚌埠医学院第一附属医院血管外科收治的16例下腔静脉变异患者的临床资料，分析其临床表现及诊治方法。结果双下腔静脉(double inferior vena cava，DIVC)变异12例，其中9例合并下肢DVT(5例合并左下肢DVT，均行下腔静脉滤器植入+导管溶栓术，3例合并右下肢DVT，行右位IVC滤器植入术，1例合并双下肢DVT, 分别于左右位IVC各置入1枚滤器)，3例合并不明原因双下肢肿胀，给予消肿治疗；左位下腔静脉(left inferior vena cava，LIVC)变异4例，其中2例因下肢肿胀行左下肢深静脉造影发现，给予消肿治疗，2例合并右下肢DVT术中经左股静脉穿刺造影发现，行下腔静脉滤器植入术，其中1例同时行置管溶栓术。放置永久性滤器1例，可回收滤器10例，所有DVT患者术后均给予抗凝治疗。结论 IVCM是静脉血栓栓塞症的重要危险因素，合适位置的下腔静脉滤器置入具有重要的临床意义。
- 下腔静脉变异 /
- 深静脉血栓形成 /
- 下腔静脉滤器
Abstract: Objective To investigate the clinical diagnosis and treatment of congenital inferior vena cava malformation (IVCM) complicated with deep vein thrombosis (DVT). Methods The clinical data of 16 patients with inferior vena cava variation treated in Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College from August 2011 to July 2021 were analysed retrospectively. Results Amongst the 12 cases of double inferior vena cava (DIVC), 9 cases were complicated with lower extremity DVT (5 cases with left lower extremity DVT underwent inferior vena cava filter implantation plus catheter thrombolysis; 3 cases complicated with right lower extremity DVT underwent right IVC filter implantation; and 1 case complicated with both lower extremity DVT was inserted with 1 filter in the left and right IVC, respectively), and 3 cases complicated with unexplained lower extremity swelling were treated with detumescence. Four cases were diagnosed with DVT in the left inferior vena cava. Amongst them, 2 cases found by left lower extremity deep venography due to lower extremity swelling were given detumescence treatment; 2 cases found by left femoral vein puncture during right lower extremity DVT were implanted with an inferior vena cava filter, of which 1 case was treated by catheter thrombolysis at the same time. There were 1 case of permanent filter and 10 cases of recyclable filter. All patients with DVT were given anticoagulant therapy after operation. Conclusion IVCM is an important risk factor of venous thromboembolism, and the placement of inferior vena cava filter in an appropriate position has important clinical significance.
- Inferior vena cava malformation /
- Deep vein thrombosis /
- Inferior vena cava filter

HTML全文

图 1 90岁患者LIVC合并右下肢DVT植入永久性滤器

注：A为深静脉造影提示右下肢DVT；B、C为造影发现左位下腔静脉变异；D为行左股静脉穿刺予下腔静脉内植入永久性滤器1枚。

Figure 1. A 90-year-old patient with LIVC combined with right lower extremity DVT was implanted with a permanent filter

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图 2 DIVC合并下肢DVT患者滤器植入情况

注：A为右下肢DVT+DIVC，于右IVC中植入滤器1枚；B、C为左下肢DVT+DIVC，滤器植入右IVC后经左腘静脉置管溶栓时发现DIVC, 将滤器回收重新植入左IVC；D为双下肢DVT+DIVC, 由于肝后下腔静脉过短，分别于左右IVC中各植入1枚滤器。

Figure 2. Filter implantation in DIVC patients with lower extremity DVT

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参考文献(21)

[1]	TRUTY M J, BOWER T C. Congenital anomalies of the inferior vena cava and left renal vein: Implications during open abdominal aortic aneurysm reconstruction[J]. Ann Vasc Surg, 2007, 21(2): 186-197. doi: 10.1016/j.avsg.2006.10.014
[2]	潘璇璇, 梁平平, 洪静. 自助式下肢功能锻炼鞋在下肢骨折术后深静脉血栓预防中的应用[J]. 中华全科医学, 2021, 19(7): 1236-1238. doi: 10.16766/j.cnki.issn.1674-4152.002029 PAN X X, LIANG P P, HONG J. Application of self-service lower limb therapeutic footwear in prevention of deep vein thrombosis after lower limb fracture surgery[J]. Chinese general practice, 2021, 19(7): 1236-1238. doi: 10.16766/j.cnki.issn.1674-4152.002029
[3]	GAYER G, LUBOSHITZ J, HERTZ M, et al. Congenital anomalies of the inferior vena cava revealed on CT in patients with deep vein thrombosis[J]. AJR Am J Roentgenol, 2003, 180(3): 729-732. doi: 10.2214/ajr.180.3.1800729
[4]	葛文, 宋樟伟, 许崇永, 等. 双下腔静脉伴左下腔静脉汇合半奇静脉及右肾静脉瘤1例[J]. 医学影像学杂志, 2010, 20(5): 727, 730. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ201005046.htm GE W, SONG Z W, XU C Y, et al. Double inferior vena cava accompanying the left inferior vena cava draining in to hemiazygos vein and right renal phlebangioma: a case report[J]. Journal of Medical Imaging, 2010, 20(5): 727, 730. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ201005046.htm
[5]	姚文暾, 赵维, 关海昕. 双下腔静脉畸形置入滤器1例[J]. 宁夏医学杂志, 2010, 32(6): 537, 478. https://www.cnki.com.cn/Article/CJFDTOTAL-NXYX201006029.htm YAO W D, ZHAO W, GUAN H X, et al. A case of double inferior vena cava malformation with filter implantation[J]. Ningxia Medical Journal, 2010, 32(6): 537, 478. https://www.cnki.com.cn/Article/CJFDTOTAL-NXYX201006029.htm
[6]	米永杰, 李健. 双下腔静脉伴睾丸静脉及肾上腺静脉变异1例[J]. 局解手术学杂志, 2011, 20(2): 227. doi: 10.3969/j.issn.1672-5042.2011.02.068 MI Y J, LI J. Double inferior vena cava with testicular vein and adrenal vein variation: a case report[J]. Journal of Regional Anatomy and Operative Surgery, 2011, 20(2): 227. doi: 10.3969/j.issn.1672-5042.2011.02.068
[7]	GRULLON J, QATO K, TRAN N N, et al. Impact of access site choice on outcomes of inferior vena cava filter placement[J]. J Vasc Surg, 2021, 74(3): 199-200.
[8]	赵刘兵, 吕献军, 徐炜, 等. 双下腔静脉畸形合并左下腔静脉及左下肢深静脉血栓形成介入治疗1例[J]. 介入放射学杂志, 2021, 30(6): 565-567. doi: 10.3969/j.issn.1008-794X.2021.06.008 ZHAO L B, LYU X J, XU W, et al. Interventional treatment of inferior vena cava duplication malformation complicated by left inferior vena cava thrombosis and left lower extremity deep vein thrombosis: Report of one case[J]. Journal of Interventional Radiology, 2021, 30(6): 565-567. doi: 10.3969/j.issn.1008-794X.2021.06.008
[9]	李万强, 彭珍山, 申家兴, 等. 双下腔静脉1例[J]. 中国临床解剖学杂志, 2007, 25(2): 117. doi: 10.3969/j.issn.1001-165X.2007.02.035 LI W Q, PENG Z S, SHEN J X, et al. Double inferior vena cava: one case report[J]. Chinese Journal of Clinical Anatomy, 2007, 25(2): 117. doi: 10.3969/j.issn.1001-165X.2007.02.035
[10]	CHEE Y L, CULLIGAN D J, WATSON H G. Inferior vena cava malformation as a risk factor for deep venous thrombosis in the young[J]. Br J Haematol, 2001, 114(4): 878-880. doi: 10.1046/j.1365-2141.2001.03025.x
[11]	苗超峰, 曹海峡, 李萌, 等. 先天性下腔静脉畸形10例临床诊断及治疗研究[J]. 中华实验外科杂志, 2019, 36(7): 1274-1275. doi: 10.3760/cma.j.issn.1001-9030.2019.07.036 MIAO C F, CAO H X, LI M, et al. Clinical diagnosis and treatment of 10 cases of congenital inferior vena cava malformation[J]. Chinese Journal of Experimental Surgery, 2019, 36(7): 1274-1275. doi: 10.3760/cma.j.issn.1001-9030.2019.07.036
[12]	刘斌, 林茜, 钟梅芳, 等. 双下腔静脉畸形并双下肢深静脉血栓形成肾上下腔静脉滤器置入1例[J]. 中国现代普通外科进展, 2021, 24(2): 166-168. https://www.cnki.com.cn/Article/CJFDTOTAL-PWJZ202102025.htm LIU B, LIN Q, ZHONG M F, et al. Application of suprarenal inferior vena cava filter placement for a patient with double inferior vena cava malformation and deep venous thrombosis of both lower limbs[J]. Chinese Journal of Current Advances in General Surgery, 2021, 24(2): 166-168. https://www.cnki.com.cn/Article/CJFDTOTAL-PWJZ202102025.htm
[13]	苏杭, 杨雷, 龚超泓, 等. 双下腔静脉畸形一例[J]. 解剖学研究, 2021, 43(2): 191. doi: 10.3969/j.issn.1671-0770.2021.02.023 SU H, YANG L, GONG C H, et al. A case of double inferior vena cava malformation[J]. Anatomy Research, 2021, 43(2): 191. doi: 10.3969/j.issn.1671-0770.2021.02.023
[14]	黄景, 文晓蓉, 张梅, 等. 左位下腔静脉变异及相关并发症的超声诊断价值[J]. 西部医学, 2020, 32(4): 559-561. doi: 10.3969/j.issn.1672-3511.2020.04.022 HUANG J, WEN X R, ZHANG M, et al. The diagnostic value of ultrasound for left inferior vena cava malformation and related complications[J]. Medical Journal of West China, 2020, 32(4): 559-561. doi: 10.3969/j.issn.1672-3511.2020.04.022
[15]	彭翼, 郭伟昌, 刘洋, 等. 静脉造影诊断左位下腔静脉1例[J]. 血管与腔内血管外科杂志, 2016, 2(6): 544-547. https://www.cnki.com.cn/Article/CJFDTOTAL-XGQW201606023.htm PENG Y, GUO W C, LIU Y, et al. A case of left inferior vena cava diagnosed by venography[J]. Journal of Vascular and Endovascular Surgery, 2016, 2(6): 544-547. https://www.cnki.com.cn/Article/CJFDTOTAL-XGQW201606023.htm
[16]	BAEKGAARD N, BROHOLM R, JUST S, et al. Long-term results using catheter-directed thrombolysis in 103 lower limbs with acute iliofemoral venous thrombosis[J]. Eur J Vasc Endovasc Surg, 2010, 39(1): 112-117. doi: 10.1016/j.ejvs.2009.09.015
[17]	ZHANG L, GUAN W K. Deep vein thrombosis in patient with left-sided inferior vena cava draining into the hemiazygos vein: A case report[J]. World J Clin Cases, 2021, 9(3): 672-676. doi: 10.12998/wjcc.v9.i3.672
[18]	陈茂国. 超声影像诊断下腔静脉变异畸形及相关并发症探讨[J]. 影像研究与医学应用, 2020, 4(7): 126-127. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202007083.htm CHEN M G. Ultrasonographic diagnosis of inferior vena cava malformation and related complications[J]. Journal of Imaging Research and Medical Applications, 2020, 4(7): 126-127. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202007083.htm
[19]	MAZENGENYA P. Multiple variations of the renal and testicular vessels: Possible embryological basis and clinical importance[J]. Surg Radiol Anat, 2016, 38(6): 729-733. doi: 10.1007/s00276-015-1584-7
[20]	黄景, 文晓蓉, 张梅, 等. 超声影像诊断下腔静脉变异畸形及并发症[J]. 心肺血管病杂志, 2018, 37(12): 1049-1052. doi: 10.3969/j.issn.1007-5062.2018.12.004 HUANG J, WEN X R, ZHANG M, et al. The ultrasound imaging diagnosis inferior vena cava malformation and complications[J]. Journal of Cardiovascular and Pulmonary Diseases, 2018, 37(12): 1049-1052. doi: 10.3969/j.issn.1007-5062.2018.12.004
[21]	SAETTELE M R, MORELLI J N, CHESIS P, et al. Use of a Trellis device for endovascular treatment of venous thrombosis involving a duplicated inferior vena cava[J]. Cardiovasc Intervent Radiol, 2013, 36(6): 1699-1703. doi: 10.1007/s00270-013-0559-5