膝窩静脈からのカテーテル血栓溶解療法により改善した深部静脈血栓症の1例

A Case of Deep Vein Thrombosis Cured by Catheter Directed Thrombolysis in the Popliteal Vein

要旨　患者は59歳，男性．左下肢腫脹，疼痛を主訴に受診．下肢静脈エコー，下肢造影CTにより左腸骨静脈から大腿静脈にかけて血栓閉塞を認め，深部静脈血栓症と診断された．入院後，ヘパリン持続点滴を開始．第2病日，エコーガイド下に左膝窩静脈にシースを挿入し静脈造影を施行．大腿静脈から腸骨静脈にかけて血栓閉塞が認められた．多孔式カテーテルをシースから血栓内に留置し，ウロキナーゼ24万単位/日の持続投与を開始した．第14病日の静脈造影では血栓はほとんど溶解していた．本治療中に出血性の合併症や肺塞栓症の併発を認めず，下肢腫脹は完全に消失し後遺症を残すことなく退院した．深部静脈血栓症に対し，経カテーテル的ウロキナーゼ持続投与が有効であった．

　A 59-year-old man was admitted to our hospital because of left lower limb swelling and pain. He was diagnosed with deep vein thrombosis due to left iliac and femoral vein occlusion observed by ultrasonography and computed tomography. Heparin was administrated on the first day and on the second day a sheath was inserted into the left popliteal vein by echo guidance. Venography demonstrated thrombotic occlusion of the iliac and femoral veins. A multi lumen catheter was inserted into the sheath and placed at the site of the thrombotic lesion. Urokinase 240,000U/day was administrated from the multi lumen catheter. After 14 days, the thrombolysis was almost completed and blood flow was fully recovered. There were no hemorrhagic complications or evidence of pulmonary embolism. The limb swelling subsided and no post thrombotic syndrome was observed. We conclude that direct catheter thrombolysis can be useful for deep vein thrombosis.