我们在此报告一名99岁的高血压和血脂异常女性。从20XX年8月开始,观察到从左大腿到脚趾的明显水肿,所以她咨询了她以前的医生。她被怀疑患有蜂窝织炎,并接受了抗生素治疗,但是她的症状没有改善,所以她被转到我们医院.小腿水肿仅局限在左小腿,到急诊室就诊时D-二聚体水平高达16.6μg/mL,所以怀疑深静脉血栓(DVT),病人立即住院。开始连续给药未分化肝素,并进行下肢静脉超声检查。因此,观察到中央型DVT从左髂静脉延伸至髂总静脉分叉处。然而,尽管将下腔静脉(IVC)过滤器注入肾静脉下方,把肝素换成30毫克的依度沙班,下肢水肿无改善。因此,基于导管的溶栓(CDT)在疾病的第11天开始,并通过导管开始持续给予尿激酶。肝素和依度沙班不联合使用以降低出血风险。水肿逐渐好转,在下肢静脉超声检查证实血栓完全消失后,在开始CDT后第14天(发病第24天)拔除导管.IVC过滤器也被移除,重新开始处方30毫克的依度沙班。由于病人在家使用步行架,她从CDT治疗开始就开始康复,一旦能够使用自持式便携式厕所就出院了。DVT的基本治疗是抗凝治疗;然而,在本例中观察到大量的血栓形成,常规抗凝治疗没有明显改善.由于患者年龄特别大,考虑到及时改善水肿以维持她的日常生活活动是很重要的,我们进行了CDT治疗,并得出结论认为在这种情况下非常有效.然而,DVT的CDT程序尚未标准化,很少有CDT治疗的病例,特别是对于这样的超级老年患者。在当前老龄化社会,DVT的发病率在增加,在像本案这样的情况下,在仔细考虑出血风险后,应考虑单独抗凝治疗和CDT治疗.
We herein report a 99-year-old woman with hypertension and dyslipidemia. From the beginning of August 20XX, significant edema from the left thigh to the toes had been observed, so she had consulted her previous doctor. She had been suspected of having cellulitis and was given antibiotics, but no improvement in her symptoms was noted, so she was transferred to our hospital. The edema of the lower leg was localized to the left lower leg only, and the D-dimer level was as high as 16.6 μg/mL at her visit to the emergency room, so deep vein thrombosis (DVT) was suspected, and the patient received immediate hospitalization. Continuous administration of undifferentiated heparin was started, and lower extremity venous ultrasound was performed. As a result, central-type DVT extending from the left iliac vein to the common iliac vein bifurcation was observed. However, despite administering inferior vena cava (IVC) filter into under the renal vein, and changing heparin to edoxaban 30 mg, no improvement in the lower limb edema was observed. Therefore, catheter-based thrombolysis (
CDT) was started on day 11 of illness, and continuous administration of urokinase was started via the catheter. Heparin and edoxaban were not used in combination in order to reduce the risk of bleeding. The edema gradually improved, and after confirming that the thrombus had completely disappeared on lower extremity venous ultrasound, the catheter was removed on day 14 (day 24 of illness) after starting
CDT. The IVC filter was also removed, and prescription of edoxaban 30 mg was restarted. Since the patient had used a walking frame at home, she started rehabilitation from the initiation of
CDT therapy and was discharged once she was able to use a self-sustaining portable toilet. The basic treatment for DVT is anticoagulant therapy; however, a large amount of thrombosis was observed in the present case, and no marked improvement was observed with conventional anticoagulant therapy. As the patient was particularly elderly, and considering that it was important to improve the edema promptly in order to maintain her activities of daily living, we performed CDT treatment and concluded that it was very effective in this case. However, the
CDT procedure for DVT has yet to be standardized, and there are few cases of
CDT treatment, especially for such super-elderly patients. In the current aging society, the incidence of DVT diseases is increasing, and in cases such as the present case, anticoagulation therapy alone and
CDT therapy should be considered and implemented after careful consideration of the bleeding risk.