2022年 · 第37卷第07期

The patient was a 74-year-old female. Admitted for intermittent claudication of right lower limb for 1 year and pain of right foot with numbness for 1 d. The patient had a history of claudication in the right lower limb for 1 year. He developed pain and discomfort in the right calf after walking about 200 meters, which was relieved after rest. Admission physical examination: the skin temperature of the right foot and right calf was low, the right foot was flushed, and the right femoral artery, popliteal artery, dorsal foot and posterior tibial artery could not be palpable. A strong pulsation can be palpable in the left femoral artery and below. Right ankle brachial index (ABI) at admission: 0.21. Ultrasound examination before admission showed that the lower femoral shaft of the right femoral artery, the whole popliteal artery and the lumen of the left reserve artery showed uneven and slightly lower recovery filling, and a weak blood flow signal passed through. Admission diagnosis: lower extremity arteriosclerosis obliterans, lower extremity arterial thrombosis. After admission, emergency incision and thrombectomy were done. During the operation, the right femoral artery was found to be slender and pulsatile. Forgarty double-lumen thrombectomy catheter was used for upward and downward thrombectomy, but the thrombus could not be removed. The lower extremity artery CTA examination showed that bilateral persistent sciatic artery (PSA) started from bilateral internal iliac artery, and the distal end of right internal iliac artery and part of PSA lumen were filled with low density parenchyma. There was no abnormality in the left popliteal artery, and the right popliteal artery had low density shadow and severe stenosis (Figures 1 and 2). Surgical treatment was performed again under DSA after department discussion. The left PSA was retrograde punctured, and a 5F-50 cm thrombolytic catheter was selected to be placed in the middle segment of the right internal iliac artery. The thrombolytic catheter was placed in the middle segment of the right internal iliac artery through the right PSA to the P2 segment of the right popliteal artery, and then returned to the ward for catheter thrombolysis. The next day's re-examination showed: the distal end of the right internal iliac artery was developed and dilated to 2 cm, about 5 cm long, the right PSA and the density in the right popliteal artery were uneven, and the thrombus remained. An 8F catheter was used to suck the thrombus, 20 ml of the thrombus was removed, and a 6-120 mm Medtronic balloon dilatation catheter was used to dilatate the right PSA and the stenosis of the right popliteal artery in fractional intervals. The contrast effect after dilatation was not good. Postoperative anticoagulation (low molecular weight heparin 4 100 IU/time, intramuscular injection at Q12 h), vasodilator medication (alprostadil 10 μ g + normal saline 100 ml, intravenous drip once a day), right lower limb ischemia symptoms gradually relieved 1 week after operation. Physical examination at discharge: the skin temperature of the right foot and right calf was good, the arterial pulsation could be palpable in the right inguinal area, and the right popliteal artery, dorsal foot and posterior tibial artery could not be palpable. Right ABI at discharge: 0.82.

The patient was a 38-year-old male. See a doctor for "swelling and pain in the left lower limb for 1 day". Two weeks ago, the patient received conservative treatment such as anti-infection, volume expansion and fluid rehydration in other hospitals for height fall injury with multiple fractures and retroperitoneal hematoma. 1 d ago, the patient felt swelling and pain in the left lower limb, without cough, chest tightness, chest pain and other discomfort. Ultrasonic examination of left lower limb vasculature after admission: blood flow in vena cava segment was unobstructed, and the lower lumen was compressed by hematoma; Thrombosis of left common and external iliac vein segments; Thrombosis of the left deep and superficial veins. Enhanced CT of the upper abdomen: retroperitoneal hematoma; Left psoas major injury; Fracture of the sacrum. inferior vena cava angiography + inferior vena cava filter (IVCF) placement was performed. Intraoperative angiography revealed that the filter had failed to deploy, and an endovascular filter retrieval attempt failed. It was determined that the filter was not in the inferior vena cava (FIG. 1A), and then the second filter was released (FIG. 1B). Exploratory laparotomy was performed on the 14th postoperative day, and the filter was partially deployed on the posterior wall of the inferior vena cava. The filter was bound with silk thread to prevent secondary tissue damage (Figure 2A), and an attempt to remove the abnormal filter failed. The filter tip retrieval hook was fully exposed (Figure 2B), and the abnormal filter was successfully grasped with a gooseneck catcher, and the connective tissue wrapped in it was seen (Figure 2C). No obvious active bleeding was seen during the operation, and the hospital was discharged 1 week after the operation, and the second normal anatomical filter was removed 3 months later.

venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), is one of the common complications that can be prevented in hospitalized patients, with high morbidity and high mortality^［1］。 At present, the prevention methods of VTE include basic prevention, mechanical prevention and drug prevention^［2］intermittent pneumatic compression (IPC) is one of the main mechanical prevention methods of VTE. As hospitals at all levels pay more attention to the prevention of VTE, how to standardize the use of IPC for scientific prevention of VTE has become an urgent problem in clinical practice. Therefore, Chinese VTE prevention and treatment medical and nursing experts based on domestic and foreign guidelines and evidence-based medical evidence, combined with clinical experience, summarized and formed an expert consensus, aiming at providing a basis for the standardized clinical application of IPC.