目的:Iliocaval静脉肿瘤血栓是一种与慢性静脉淤滞相关的病态,下肢水肿/疼痛,严重血流阻塞继发的广泛血栓负担和高死亡率,心内血栓扩展和肿瘤栓塞。通常对药物治疗有抵抗力,管理主要是外科,为患有广泛或终末期疾病的医学复杂患者带来挑战。机械或抽吸血栓切除术代表了一种有吸引力的治疗策略,但缺乏数据。
方法:我们执行了单中心,10年,回顾性回顾病理证实的患者,接受血栓切除术的髂腔肿瘤血栓。在此期间,有14例患者符合纳入标准,并通过18例手术进行管理。
结果:最常见的恶性肿瘤是肾细胞癌(n=7;50%);其他类型包括生殖细胞(n=2;14%),其他泌尿生殖系统(n=2;14%),神经内分泌(n=1;7%),软组织(n=1;7%),和皮肤细胞恶性肿瘤(n=1;7%)。所有患者均有累及远端下静脉静脉(IVC)的血栓,50%有双侧髂关节受累,29%有心房受累。常见的适应症是静脉阻塞症状(n=11;65%)和栓塞的证据(n=6;35%)。所有患者均耐受该程序,无急性并发症。技术成功率为94%,随着流量的显著改善和血栓负担的减少,79%主观症状改善。所有患者存活>2周,50%的患者长期存活>1年,这些患者中有86%患有肾细胞癌(RCC)。三名患者在几天到几周内接受了多次血栓切除术,最终症状改善。
结论:总体而言,我们的研究结果提示,对于髂腔肿瘤血栓患者,机械或抽吸取栓是一种安全有效的治疗方法.
OBJECTIVE: Iliocaval venous tumor thrombus is a morbid condition associated with chronic venous stasis, lower extremity edema/pain, extensive thrombus burden and high mortality secondary to critical flow obstruction, intracardiac thrombus extension and tumor embolization. Typically resistant to medical therapy, management is primarily surgical, presenting challenges for medically complex patients with widespread or end-stage disease. Mechanical or aspiration thrombectomy represents an appealing treatment strategy but data are lacking.
METHODS: We performed a single-center, 10-year, retrospective review of patients with pathology-confirmed, iliocaval tumor thrombus who underwent thrombectomy. 14 patients met inclusion criteria and were managed by 18 procedures over this period.
RESULTS: The most common malignancy was renal-cell carcinoma (n=7; 50%); other types included germ cell (n=2; 14%), other genitourinary (n=2; 14%), neuroendocrine (n=1; 7%), soft tissue (n=1; 7%), and skin cell malignancies (n=1; 7%). All patients had thrombus involving the distal inferior venous cava (IVC), 50% had bilateral iliac involvement and 29% atrial involvement. Common indications were venous obstruction symptoms (n=11; 65%) and evidence of embolism (n=6; 35%). All patients tolerated the procedures without acute complication. The technical success rate was 94%, with marked improvement of flow and reduction in thrombus burden, and 79% had subjective symptomatic improvement. All patients survived for >2 weeks and 50% had long-term survival of >1 year, with 86% of these patients having renal-cell carcinoma (RCC). Three patients underwent multiple thrombectomies within days to weeks, with ultimate symptomatic improvement.
CONCLUSIONS: Overall, our study results suggest mechanical or aspiration thrombectomy as a safe and efficacious treatment for patients with iliocaval tumor thrombus.