Fogarty balloon catheter iliofemoral vein thrombectomy

Fogarty with cystic iliac vein thrombectomy for the treatment of iliofemoral venous thrombosis. The iliac vein thrombosis refers to thrombosis in the total iliac vein, the external iliac vein, and the common femoral vein. Because it is the main way of venous return of the lower extremity, once the venous thrombosis is formed, in addition to the early treatment, the deep vein dysfunction of the lower extremity will generally be left behind. There is a long-standing debate about whether the formation of iliac vein thrombosis should be performed by surgical thrombectomy. In the 1950s, many scholars advocated surgical thrombectomy. At that time, it was mainly used for incision and thrombectomy. After the 1960s, the Fogarty balloon catheter was used to remove the thrombus, which improved the efficiency. Since the 1970s, thrombectomy has been denied by many scholars. It is believed that the incidence of deep venous insufficiency cannot be reduced. On the other hand, many scholars still perform surgical thrombectomy. In short, the indications for surgery should be strictly controlled. Treating diseases: venous thrombosis Indication Primary iliofemoral vein thrombosis, the incidence of no more than 48h, the thrombectomy has a good effect. On the 3rd to 4th day, the vein wall began to thicken, and the inflammatory reaction began to appear. It is easy to form a thrombus again after the thrombus, so the curative effect is poor. After 5 days, the lesion has entered the advanced stage, and it is generally inappropriate to perform surgery for thrombectomy. Contraindications 1. Thrombotic phlebitis, which is usually formed by deep veins and venules of the thigh or calf, and combined with different degrees of inflammatory reaction, and then the thrombus gradually extends upward to the iliac vein. 2. The formation of primary iliac vein thrombosis, the disease has been more than 5 days. 3. Severe cardiopulmonary dysfunction. Preoperative preparation 1. Definitive diagnosis, if necessary, do venography to determine the location and extent of embolization. 2. Prepare blood for 600 to 1000 ml for use in surgery. Surgical procedure Epidural block anesthesia or general anesthesia may be used, or local infiltration anesthesia may be used. The patient was supine and the lower extremities were externally rotated. 1. Both sides of the inguinal incision, revealing the common femoral vein, free 5 ~ 6cm, bypassing two rubber bands. At the same time, the confluence of the great saphenous vein femoral vein was observed. 2. Insert the F5 Fogarty balloon catheter into the inferior vena cava through the contralateral saphenous vein or its branch, inject saline to fill the water capsule, and temporarily block the blood flow of the inferior vena cava to prevent the thrombus from falling off. At the same time, the second Fogarty tube was inserted from the affected femoral vein. 3. Tighten the affected femoral vein control band, insert a second Fogarty balloon catheter through the femoral vein incision directly above the thrombus, at this time intravenous injection of heparin 50mg. The second Fogarty tube is filled with water, and the water in the first tube is released to restore blood flow. The second Fogarty tube was pulled out and the thrombus was removed from the femoral vein incision. After the proximal end of the thrombus, check whether there is a thrombus at the distal end. If there is a thrombus, the thrombus can be overflowed with a slight compression. If necessary, the Fogarty tube can be inserted into the distal end of the thrombus. The complete removal of the thrombus is characterized by a large amount of blood in the distal and proximal ends.