目的：分析在急性髂股股动脉静脉血栓形成(IFPVT)导管内直接溶栓(CDT)的可行性和结果。
方法：从2020年6月至2021年6月，共纳入26例（26条下肢）接受CDT治疗IFPVT的患者。根据血管通路,将患者分为UOA组(n=11,10条左肢和1条右肢)和同侧髂静脉(ILPV)组(n=15,15条左肢)。比较两组患者术前特点和技术细节的差异。
结果：UOA组患者年龄大于ILPV组患者（67.64±4.11岁VS。52.73±15.63年，p=.003）。UOA组BMI显著高于ILPV接入组(26.03±1.62kg/m2VS24.71±1.46kg/m2,p=.039)。UOA组同时有三种合并症的患者明显多于ILPV接入组(45.5%vs.0，p=.043）。与ILPV接入组相比，UOA组的手术时间和透视时间明显延长（20.64±3.41minvs.10.20±1.42min,p<.001;18.18±2.99minvs.6.13±0.92min,p<.001),但技术成功率明显较低(54.5%vs.100%,p=.007）。在UOA组中，手术相关并发症的发生，包括导管偏离骶外侧静脉（9.1％），腹膜后血肿（9.1%），和血栓脱落进入过滤器(9.1%)。
结论：UOA可在不能倾向的患者中尝试，但这种途径不是CDT的最佳途径。
OBJECTIVE: To analyze the feasibility and results of up-and-over access (UOA) for catheter-directed thrombolysis (CDT) in acute iliofemoral
popliteal venous thrombosis (IFPVT).
METHODS: From June 2020 to June 2021, a total of 26 patients (26 lower limbs) undergoing CDT for IFPVT were included. According to the vascular access, the patients were divided into UOA group (n = 11, 10 left limbs and 1 right limb) and ipsilateral
popliteal vein (ILPV) (n = 15, 15 left limbs) access group. The differences in preoperative characteristics and technical details between the two groups were compared.
RESULTS: Patients in UOA group were older than those in ILPV access group (67.64 ± 4.11 years VS. 52.73 ± 15.63 years, p = .003). The BMI of UOA group was significantly higher than that of ILPV access group (26.03 ± 1.62 kg/m2 VS 24.71 ± 1.46 kg/m2, p = .039). There were significantly more patients with simultaneous three comorbidities in UOA group than in ILPV access group (45.5% vs. 0, p = .043). Compared with ILPV access group, the duration of operation and fluoroscopy of UOA group were significantly longer (20.64 ± 3.41 min vs. 10.20 ± 1.42 min, p < .001; 18.18 ± 2.99 min vs. 6.13 ± 0.92 min, p < .001), but the technical success rate was significantly lower (54.5% vs. 100%, p = .007). In UOA group, the operation-related complications occurred, including catheter straying into lateral sacral vein (9.1%), retroperitoneal hematoma (9.1%), and thrombus shedding into filter (9.1%).
CONCLUSIONS: The UOA may be attempted in patients who are unable to be prone, but this access is not an optimal pathway for CDT.
