Study On The Effect Of Balloon Dilatation In The Treatment Of DVT Combined With Cockett Syndrome

Objectives Cockett syndrome is also called "iliac vein compression syndrome" is due to the anatomical abnormality(left iliac vein was clampped between right iliac artery and fifth lumbar spine),two kinds of oppression lead to the left common iliac venous blood tube cavity narrow.lower limb venous blood backflow is blocking,lead to the increase of the lower extremity venous pressure,then pathological changes have also taken place in the vascular wall(vascular wall proliferation,endothelial injury and etc).The combination of these pathological factors often leads to a series of clinical symptoms such as: phlebeurysma(on the shank),The left leg feels heavy,acid,distension,numbness,and etc.The prolonged absence of treatment it develops pigmentation of the left leg and ulcers that are not healed.In addition,Cockett syndrome often causes acute lower extremity deep vein thrombosis(DVT)when it meets some high risk factors(lower limb braking after injuring,long-term lying in bed,delivery and etc.).It showing that the left leg spitting edema suddenly,when the whole limb swelling,accompanied by severe pain at the same time,serious bruises will lead to the puny pulse,limb tight green purple along with blisters,can happen at the same time.endanger the patients life.If patients with acute lower extremity DVT do not receive timely,effective and standardized treatment,post hrombotic syndrome(PTS)can cause significant inconvenience to patients' daily life.Current cavity intervention technology matures,catheter thrombolysis,balloon dilatation,stent implantation,etc,with its high technical success rate,small trauma,complication is relatively small,has been the preferred treatment for acute DVT combined with Cockett syndrome.The purpose of this study was to explore the effect of balloon dilation in the treatment of patients with acute DVT combined with Cockett syndrome.To find a more reasonable operation method to treat acute DVT combined with Cockett syndrome.Methods Retrospective analysis of 25 patients with acute left leg DVT combined with Cockett syndrome from September 2015 to April 2017 in He Bei General Hospital affiliated to North China University Of Science And Technology.Before thrombolysis in 25 patients,the patients were placed the inferior vena cava filter in their postcava,and 25 patients were divided into 2 groups according to the timing of balloon dilation during the treatment.Group A: under the protection of the inferior vena cava filter.first,expanding and formming iliac vein,after that catheter thrombolysis was performed.Group B: direct catheter contact thrombolysis under the protection of inferior vena cava filter.After thrombolysis,the iliac vein stent was inserted into the iliac vein stenosis,At the end of the treatment,two groups were compared by the data of urokinase dosage and thrombolytic treatment time,the swelling rate,thrombolysis rate.Results There were no deaths in both groups.There was no statistical difference in age composition and disease time between the two groups(P > 0.05).The difference of urokinase dosage(T=6.6,P=0.000)in the two groups was statistically significant(P < 0.001).There were statistically significant differences between the two groups of thrombolytic days(T=4.21 P=0.000)(P < 0.001).There was a statistically significant difference of the swelling rate between the two groups(T=2.21,P=0.03)a week after the surgery(P < 0.05).There was no difference of the swelling rate between the two groups(T=1.21,P=0.26)a month after the surgery(P>0.05).There was no statistically significant difference between the thrombolysis rate(T=0.68,P=0.48)between the two groups(P>0.05).Seven patients in group A have IVCF thrombolysis after 24 hours thrombolysis.When the angiography was taken two weeks later,two of the cases were completely dissolved,and the other 5 cases remained.In one case,a large mural thrombus was found,considering the age of the patient(77 years old)make the IVCF become permanent.The other 14 cases were successfully removed.four of them have thrombus in the filter.The thrombus was smaller,with a diameter of less than 0.8cm.The patients in group B had no thrombus at all stages during the treatment,and 11 patients in group B were successfully removed after two weeks,and no thrombus was found in the IVCF.Conclusions In the treatment of patients with acute left lower limb DVT and Cockett syndrome:(1)First taking the left iliac vein balloon dilatation can improve the utilization rate of urokinase during thrombolysis and shorten the time of thrombolysis.?(2)First takingiliac vein balloon dilatation compared with direct catheter thrombolysis,in the short term(1 week)the difference is obvious,fewer complications,but the recent curative effect have no difference(1 month).(3)The expansion of the liac vein may lead to fall off of the thrombosis,and the placement of the inferior vena cava is necessary.(4)Due to the natural barrier of the compressed iliac vein,the thrombus did not fall off.