血管外科疾病Vascular+Disease课件

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1、Vascular Diseases血管外科疾病血管外科疾病ZHAO JICHUN（赵纪春）（赵纪春）M.D.&Ph.D.Vascular Surgery,West China Hospital,Sichuan UniversityContentPart I Theoverviewofvasculardisease 血管外科疾病总论Symptomsandsigns 症状和体征Part II Part II Commonvasculardiseases(arteryandveindisease)血管外科常见疾病TheoverviewofvasculardiseaseSymptomsandsigns

2、血管外科疾病概述Part I IntroductionArterialandvenouscirculationVascular:cardiovascularcerebrovascular(intracranial)peripheralvascularIntroductionPeripheralvasculardiseases:comprisedisordersofthearteriesandveins,butexcludecardiovascularandcerebrovascular.除心血管及脑血管系统之外的所有循环系统疾病Classification分类CharacteristicsAr

3、terial diseaseVenous diseaseMixed disease ShapeStenosis 狭窄狭窄Rupture 破裂破裂 Occlusion 闭塞闭塞 Dilation 扩张扩张 Arterial Disease:Aneurysm（动脉瘤）（动脉瘤）Stenosis（动脉狭窄）（动脉狭窄）Occlusion（动脉闭塞）（动脉闭塞）Rupture（动脉瘤破裂）（动脉瘤破裂）Venous Disease：Varicose vein（静脉曲张）（静脉曲张）Venous thrombosis（静脉血栓形成）（静脉血栓形成）Mixed DiseaseArteriovenous f

4、istula（动静脉瘘）（动静脉瘘）Abdominal aortic aneurysm,AAA腹主动脉瘤腹主动脉瘤Internal Carotid aneurysm颈内动脉瘤颈内动脉瘤 1892年，加拿大、美国等国的基督教会在成都创办仁济、存仁医院 历史沿革历史沿革 1892年，加拿大、美国等国的基督教会在成都创办仁济、存仁医院 历史沿革历史沿革 Renal artery stenosisAortoiliac Occlusion主髂动脉闭塞主髂动脉闭塞Varicose Vein静脉曲张静脉曲张14Acute Deep Venous Thrombosis(DVT)深静脉血栓形成深静脉血栓形成Cl

5、inical manifestation临床表现HeartOrgans and tissuesarteryveinischemiaCongestionArterial blood carry oxygen and nutritional materials from heart to organs or tissues of the whole body.Arterial stenosis and occlusion will cause ischaemia of organ and tissue,which will present the symptoms and signs of art

6、erial insufficiency,such as lower limb ischaemia.ARTERY：VEIN:Transfer metabolic products from organs and tissues to heart and evacuate them via lung and kidney.The blood flow in vein is on one direction forward heart which depend on:muscle contraction（肌肉收缩力）（肌肉收缩力）negative pressure during inhaling o

7、f lung and diastole of heart （心肺的（心肺的“抽吸作用抽吸作用”）vein valves（静脉瓣）（静脉瓣）Clinical manifestation临床表现Sensation 感觉感觉Color 颜色颜色Shape 形态形态Nutrition 营养性变化营养性变化Sensation abnormality感觉异常Pain 疼痛疼痛Intermittent pain 间歇性疼痛间歇性疼痛1.Intermittent claudication 间歇性跛行间歇性跛行2.Position pain 体位性疼痛体位性疼痛3.Temperature pain 温度性疼痛温

8、度性疼痛Position pain体位性疼痛HeartOrgans and tissuesarteryveinIschemia缺血缺血Congestion肿胀肿胀LimbLimbdifficultaggravaterelieveeasyTemperature pain温度性疼痛Ischemia缺血缺血Congestion肿胀肿胀WarmExpand vessel血管扩张血管扩张-+ColdContract vessel血管收缩血管收缩+-Sensation abnormality感觉异常PainPersistent pain(rest pain):ischemia,inflammation,n

9、ecrosis持续性疼痛（静息痛）：缺血，炎症，坏死持续性疼痛（静息痛）：缺血，炎症，坏死1.Artery rest pain 2.Vein rest painSensation abnormality感觉异常Skin temperature 皮肤温度皮肤温度Artery stenosis or occlusion:decreasedVein occlusion:increasedNumbness and paralysis 麻木和麻痹麻木和麻痹Early stage（早期）（早期）:numbness 麻木麻木Later stage（晚期）（晚期）:paralysis 麻痹麻痹Color ab

10、normality皮肤颜色异常Arterial disease动脉疾病动脉疾病Venous disease静脉疾病静脉疾病ColorPallor 苍白苍白Flare 红肿红肿Pressure testDelayed return of capillary blushExercise testPallor+Flare+Position testElevate:pallor+Drop back induce returnElevate:Flare-+:aggravate -:relieveShape abnormality形态异常Atrophy萎缩萎缩:arterial occlusionSwol

11、len肿胀肿胀:venous diseaseAbnormal growth生长异常生长异常:venous diseaseLocal nodule局部结节局部结节:varicose veinsConstruction abnormality营养性障碍Necrosis or gangrene坏死或坏疽坏死或坏疽:arterial ischemiaUlcer溃疡溃疡:venous diseaseOthers manifestationPulselessness 无脉无脉:arterial occlusionFemoral APopliteal ADorsalis pedis Aposterior t

12、ibial APulse:absent,decreased,ornormal-ComparingapulsewiththatinthecontralateralextremitycandemonstratechangesindicativeofproximalstenosisorocclusionOthers manifestationPulsating mass:arterial aneurysm 搏动性包块：动脉瘤搏动性包块：动脉瘤Murmur or tremor:A-V fistula 震颤：动静脉瘘震颤：动静脉瘘arteryveinVEINStenosis狭窄狭窄 Obstructio

13、n闭塞闭塞Valve function insufficiency静脉瓣膜功能不全静脉瓣膜功能不全 varicoseveinstagnationswellingIschaemiaClinical ManifestationVEIN?ARTERY?Acute?or Chronic?HISTORY IN PATIENTS WITH ARTERIAL DISEASEacute arterial occlusion急性动脉闭塞急性动脉闭塞chronic arterial insufficiency慢性动脉缺血慢性动脉缺血6Pssign6P征:pain疼痛Paresthesias感觉异常Paralysi

14、s麻痹poikilothermy(changewithtemperature,coolextremity)变温性Pallor苍白Pulselessness无脉chronicorlong-standingsymptomsandencompassesaspectrumofsymptoms,beginningwitheffortdiscomfort(claudication)andprogressingtopainatrestandtissueloss.（间歇性跛行 静息痛）HISTORY IN PATIENTS WITH VENOUS DISEASchronic venous occlusion

15、or valvular incompetence with venous reflux慢性静脉闭塞/静脉功能不全acute venous thrombosis急性静脉血栓形成 pain or discomfort and swelling of the extremity（疼痛，不适或肢体肿胀）venous hypertension and edema（静脉性高压及静脉水肿）venous stasis ulcers（静脉性溃疡）Commonvasculardiseases(arteryandveindisease)血管外科常见疾病Part II 35Thromboangiitis Oblite

16、rans（Buergers Disease）血栓闭塞性脉管炎血栓闭塞性脉管炎 PathogenesisThedefinitiveetiology:AtpresentunknownSmokingplaysacrucialrole.吸烟吸烟是主要诱因60-95%have the history of smoking60-95%吸烟史Ithasbeensuggested:Buergersdiseaseisanautoimmunedisorder（自身免疫性疾病）Theautoimmuneresponsemaycausedysfunctionoftheendothelialcellswithincre

17、asedpropensitytothrombosisandvasoconstriction（免疫反应导致内膜损伤血栓形成/血管痉挛）PathogenesisMain PathologyBuergersdiseaseisaninflammatorynonatheroscleroticdiseaseofthesmalltomedium-sizedarteriesandveins炎性反应主要累及中小血管Clinical manifestationClinicalpictureisdominatedbysignsofskinischemiarangingfromRaynaudsphenomenon（雷

18、诺现象）（雷诺现象）tosignsoflocalcriticalischemiaandeventualgangrene.Symptoms and signs Including:young man(aged:18-50),heavy smoker 青年男性青年男性 吸烟史吸烟史 Pain:most at fingers or toes 肢端疼痛肢端疼痛 Abnormality in colour and temperature 皮肤颜色及温度异常皮肤颜色及温度异常 Migratory superficial phlebitis 游走性浅静脉炎游走性浅静脉炎 Pulselessness 无脉无脉

19、 Ulcer and gangrene 溃疡和坏疽溃疡和坏疽Figure 7-11 Schematic representation of symptoms and signs in Buergers disease 吸烟 Smoking Inflammatory Young men 青年男性 disease medium to small size 炎症反应累及中小血管 Arteries Veins Skin Muscle Phlebitis migrans 浅静脉炎Raynaudss Ulcers 溃疡 Gangrene坏疽 Claudication 间歇性跛行 attacks 雷诺现象

20、Infection 感染Clinical Stages 临床分期临床分期：Stage1：Intermittentclaudication间歇性跛行Stage2：PersistentPain(restpain)静息痛Stage3：Ulcerandgangrene溃疡和坏疽Physical examination:SkinTemperature,Sensation,PulseofarterySpecial examination：Dopplor Ultrasound:bloodflow,patencyandlesionsite Noninvasive examination:Bloodpressu

21、re,ABI Arteriography图图1 1 左侧股浅动脉下段左侧股浅动脉下段图图2 2 左侧股浅动脉下段左侧股浅动脉下段图图3 3 右侧胫前动脉频谱右侧胫前动脉频谱图图4 4 右侧足背动脉频谱右侧足背动脉频谱Femoral artery occludedDifferential Diagnosis 鉴别诊断鉴别诊断 Atherosclerosis occlusion(ASO)动脉粥样硬化闭塞动脉粥样硬化闭塞:olderage(50yearsold)老年患者hyperlipidemia高脂血症hypercholesterolemia高胆固醇血症hypertension高血压diabete

22、s糖尿病 Embolic occlusive disease 动脉栓塞动脉栓塞(Five“P”signs5P征:Pain,Pallor,Pulselessness,Paraesthesia,Paralysis)Aortoiliac Occlusion主髂动脉闭塞主髂动脉闭塞Femoral artery occluded 股动脉闭塞股动脉闭塞Figure 7-14 Principles of treatment of Buergers disease血栓闭塞性脉管炎的治疗原则Stop SmokingAlpha blocking Cure local agents infectiona受体阻断剂C

23、alcium Relief of Amputationantagonists ischemia 截肢钙离子拮抗剂Iloprost Bypass前列素类药物 Sympathectomy surgery Surgery(1)Sympathectomy（交感神经切除术）:Stage1or2.Lumbarsympatheticganglionectomyandtrunkresectionwhichbasedontheevidencethattheskinandmusclevesselsandthecollateralsweresuppliedbysympatheticvasoconstrictorne

24、rves(2)Bypasssurgery（搭桥手术）:Stage2or3Femoropopliteal Bypass股动脉膝上膕动脉搭桥Infrapopliteal Bypass膝上膝下膕动脉搭桥Femoropopliteal BypassArterial anastomosisIn Situ Saphenous Vein Arterial BypassEndovascular TherapyPercutaneous Transluminal Angioplasty,(PTA)经皮腔内血管成形术经皮腔内血管成形术Balloon and Stent Placement 球囊扩张和支架置入球囊扩张

25、和支架置入Abdominal Aortic Aneurysm腹主动脉瘤Albert Einstein 死于腹主动脉瘤 一种血管扩张性疾病Abdominal Aortic AneurysmAbdominal Aortic Aneurysm （AAAAAA）腹主动脉瘤正常主动脉正常主动脉腹主动脉瘤腹主动脉瘤1Definition:Aneurysms are defined as focal dilatations at least 50%larger than the expected normal arterial diameter腹主动脉局限性异常扩张，与正常血管相比，局部血管直径永久性增大超

26、过1.5倍A practical working definition:AbdominalAorticAneurysm 3 cmCommon Iliac Aneurysm 1.8 cm腹主动脉的直径超过3cm，可以诊断为腹主动脉瘤髂总动脉的直径超过1.8cm，可以诊断为髂总动脉瘤The Normal Aortic Diameter gradually decreases Thorax(28 mm in men)Infrarenal location(20 mm in men).Womenman 2mm男性主动脉直径在各个层面比女性大2mmnNearlyallAAAsinvolvetheinfr

27、arenalaorta,Onlyabout5%to15%ofAAAsundergoingsurgicalrepairalsoinvolvethesuprarenalaorta绝大部分腹主动脉瘤为肾动脉下型nRupture!腹主动脉瘤未能得到及时诊断和治疗,就有可能发生破裂死亡Epidemology Of AAAsIncidenceofAAAsoftheWolrd：3-117/100,000/yrs60岁以上男性AAA发病率：4-8%人口老龄化AAAs的发病率美国就有约200万名AAA患者，每年的新发病人在20万例以上RAAAs：15thleadingcauseofdeathoverall10t

28、hleadingcauseofdeathinmenolderthan55y大多数AAAS没有临床症状，难以发现和及时就诊无声的杀手无声的杀手美国一年有大约15,000名患者死于AAAs，死亡率和艾滋病相当Evaluation of Risk for Rupture(Annual)破裂风险的评估(每年)4.0-5.4 cm0.6%5.5-6.4 cm10%6.5-6.9 cm19%7.0-7.9 cm35%8.0 cm51%Evaluation of Increasing Speed(Annual)瘤体增大速度的评估(每年)5 cm 0.3-0.7 cm动脉瘤直径破裂风险瘤体增大速度Incide

29、nce of Rupture(AAAs)Early Diagnosis and Treatment for AAAs82%of RAAAs DieMotalityofRAAAafterarrivinghospital:50%破裂腹主动脉瘤患者被送到医院：死亡率为50%MotalityofRAAAsforoperation：30-70%破裂腹主动脉瘤的手术死亡率：30-70%Motality of AAAs for Elective Surgery:2-7%腹主动脉瘤的择期手术死亡率仅为2-7%AAA can be detected by UltrasoundRisk Factors for A

30、AAsRisk Factors for AAAs腹主动脉瘤的危险因素腹主动脉瘤的危险因素nOldAge65ynMalenFamilyHistory一级男性亲属:20%nPastHistory既往史nAneurysmnAtherosclerosisnHypertensionnCOPDnInfection/InflammationnSmoking筛查患者的一级男性亲属！筛查患有动脉粥样硬化的吸烟老年男性Diagnosis for AAAsDiagnosis for AAAsnSymptoms:nMost of AAAs are Asymptomatic 多数腹主动脉瘤患者没有症状 通常因慢性后背疼

31、痛或肾结石行CT或超声检查而偶然发现nSymptomatic AAAs shows possibility of rupture 有症状的腹主动脉瘤（后背-胁部-腹部疼痛）提示近期破裂可能Diagnosis for AAAsDiagnosis for AAAsnPhysical Examination:nPulsatile Mass 腹正中搏动性包块nContinuous Vascular Murmur:Aortic-Vena Cava Fistula 闻及持续性血管杂音提示主动脉腔静脉漏nSensibility and Specificity:Low 敏感性 和 特异性低：80%漏诊Ultr

32、asound:Most effective for diagnosis超声筛查能够避免 70%AAA破裂导致的死亡 nAdvantages of Ultrasound:Sensibility and Specificity:High 敏感性高：82-99%Noninvasive 64-81岁男性AAA筛查研究 Cheap36Further Diagnosis for AAAsFurther Diagnosis for AAAsnCTA：Golden StandardnAdvantage:薄层扫描 3mmn快速：15-30秒，单次屏气n空间分辨率高，精确n可以进行三维重建n受操作医师/技师判断影

33、响小nDisadvantages:Radiation Exposure;Contrast nephropathynMRA nDSA 用于动脉瘤长度的测量，无法测量动脉瘤的直径，不能替代CT或者MRIPrinciple for Treatment of AAAsPrinciple for Treatment of AAAs国际上遵循以下原则Diameter of AAAPrinciple5cmSymptomatic Annual Growth Rate1cmOpen Surgery or EVER血管腔内修复术（EVAR）Treatment of AAAsTreatment of AAAs开腹手

34、术（Open Surgery）Open SurgeryAdvantages:1stOpenSurgery(1951Dubost)50yearsofclincalexperienceLong-termEffect:Good!Disadvantages:HugeIncision3090minforclampingTimeforSurgery:LongSlowRecoveryICU12d住院714d完全恢复46wOpen SurgeryContraindication:HighRiskofAnesthesia麻醉风险高麻醉风险高Cardiac/RespiratoryDysfunction心肺功能异常

35、PastSurgicalHistoryofAbdomen既往腹部手术史Complication:Pseduoaneurysm假性动脉瘤(3%)SexualDysfunction性功能障碍(25%)AortoentericFistula主动脉肠瘘(1-2%)GraftThrombosis移植物血栓形成(2%)GraftInfection移植物感染(1-2%)腹主动脉瘤腔内修复治疗（EVAR）Advantages:Advantages:nMinimalInvasive微创nFemoralArteryApproach股动脉入路，无需开腹nLowMortality死亡率低nShortTimeforSu

36、rgey手术时间短腹主动脉瘤腔内修复治疗（EVAR）Advantages:Advantages:nQuick Recovery Quick Recovery 术后恢复快术后恢复快nNo ICUnLength of Hospital Stay:DecreasenQuality of Life:High Quality of Life:High 术后生活质量高术后生活质量高nPainnIncidenceofparalysisnSexualDysfunctionStent for AAAs肾上锚定通用型接口外倾和逐渐变细的支架延长段镍钛合金材料：可行MRI检查中间的C-bar结构兼具支撑力和柔韧性牢

37、固可靠的聚酯覆膜+腹主动脉瘤腔内修复治疗腹主动脉瘤腔内修复治疗（Endovascular Repair for AAA)腔内修复治疗（EVAREVAR）Anatomy Condition 解剖条件合适解剖条件合适VacularAccess血管通路LengthandTortuosityofNeck主动脉瘤颈长度和扭曲程度CalcificationofVessels血管钙化Accurate Calculation 测量精确测量精确3mmCT薄层扫描Devices 良好的显影成像设备良好的显影成像设备Follow up 强烈建议患者术后每年随访复查强烈建议患者术后每年随访复查TRIALEVAROPE

38、NP值值EVAR I(#)*54353930天死亡率天死亡率1.7%4.7%0.04二次干预二次干预6.9%2.4%0.0001DREAM(#)*17117430天死亡率天死亡率1.2%4.6%0.1 手术死亡率手术死亡率和严重并发症和严重并发症4.7%9.8%0.1随机对照研究证实 EVAR 相对于开放手术的优越性Comparision of EVAR and Open SurgeryNote:*Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm(EVAR tri

39、al 1):randomized controlled trial Lancet Vol 365 June 25,2005*A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms the NEJM Vol 351 Oct.14,2004Preoperative Evaluation CTAPRIMARY VARICOSE VEIN OF LOWER EXTREMITY下肢静脉曲张下肢静脉曲张IntroductionVaricoseveinsaredilated

40、,tortuousandprominentsuperficialveinsinthelowerlimb下肢浅表静脉的迂曲，扩张2%ofthepopulationhasvaricosevein,theincidenceofvaricoseveinincreasewithageLong saphenous vein 大隐静脉大隐静脉 Tributariessapheno-femoraljunction-femoralvein,noarteryaccompaniedandmusclesupportShort saphenous vein 小隐静脉小隐静脉 poplitealveinSuperfici

41、al Veins1.Anatomy and physiology2.Deep Veins 深静脉：深静脉：anteriortibialveinposteriortibialveincommonfemoralveincommoniliacveininferiorvenacavapoplitealveinSuperficialfemoralveinDeepfemoralvein3.Communicating vein 交通静脉交通静脉4.Valve 静脉瓣静脉瓣5.Dynamics：Thebloodflowinveinisononedirectionforwardheartwhichdependo

42、n:musclecontraction肌肉收缩力negativepressureduringinhalingoflunganddiastoleofheart心肺“抽吸作用”veinvalves preventretrogradeflowofbloodinaproximal-to-distaldirection静脉瓣防止倒流Cause of diseaseGenetic factor 遗传因素遗传因素Acquired factor:increased vein gravity 静脉压力增加静脉压力增加longstandingwork长期站立heavyphysicallabor负重Pregnacy

43、怀孕 Clinical manifestation临床表现Early stage（早期）（早期）:Veindilatedandtortuous静脉迂曲，扩张Middle stage（中期）（中期）:Swollen,itch 下肢肿胀，皮肤瘙痒Late stage（晚期）（晚期）:Pigementation,Ulcer皮肤色素沉着，皮肤溃疡Ulcer Development:(a)Pressureandstasis(b)Arteriovenousshunts(c)Thefibrindiffusionblock(d)Whitecelltrappingandactivation Physical E

44、xaminationThe Trendlenburg Test 大隐静脉瓣膜功能试验ToassessthedirectionofbloodflowandtherefillingofthesuperficialveinsPerthes Test 深静脉通畅试验ToassessifthedeepveinwerecompetentandunobstructedDifferential Diagnosis 鉴别诊断鉴别诊断1.Chronicvenousinsufficiency慢性静脉功能不全2.Congenitalvenousabnormality先天性静脉畸形3.Post-thromboticsy

45、ndrome深静脉血栓后遗症4.Ateriovenousfistulae动静脉瘘TREATMENTMainobjectives1.Satisfactorycosmesis美容效果2.Reliefofsymptoms减轻症状3.Treatmentofcomplications治疗并发症4.Preventionofcomplications预防并发症5.Preventionofrecurrence防止复发General treatmentExternal elastic compression:静脉弹力袜静脉弹力袜supportstockings:relievingsymptomsScleroth

46、erapy:硬化剂注射硬化剂注射obliterationofvaricoseveinsandconnectionsbetweenthesuperficialanddeepveinsSurgical treatment of varicose veins1.Highligationanddivisionofthelongsaphenousveinanditstributariesatthesapheno-femoraljunction大隐静脉高位结扎2.Strippingthelongsaphenousvein大隐静脉剥离3.Avulsion,ligationorexcisionofvarico

47、sevein曲张静脉剥脱术Deep Venous Thrombosis下肢深静脉血栓形成下肢深静脉血栓形成 IntroductionDeepVenousThrombosis(DVT)isabloodclotthatformsinaveindeepinthebody.静脉血栓是多种原因导致人体静脉血管内血栓形成的疾 病，被视为第三大常见血管疾病Mostdeepveinclotsoccurinthelowerlegorthigh 最常见的静脉血栓是下肢深静脉血栓 Incidence of DVT(Annual）:1.45/1000Risk Factors for DVT 深静脉血栓形成的危险因素深

48、静脉血栓形成的危险因素1.Vessels Injury 各种原因引起血管壁损伤2.Abnormality of Blood Flow 血流异常（如血流缓慢或淤积）3.Hypercoagulative State 血液成份改变（如高凝状态）Incidenceforinpatientin1week:15%in2-12weeks:9%-94%Incidenceforpostgeneralsurgery:19%Incidenceforpostorthopaedicprocedures：40-60%IncidenceofDVTforPregnancyEpidemiology of DVTClinical

49、 ManifestationPain疼痛Flares皮肤暗红Swelling肿胀IncreasedSkinTemperature皮温增高DilationandTortuousofSuperficalVein浅静脉迂曲PulmonaryEmbolism(PE)：最严重的并发症CriticalPE(morethan50%ofpulmonarycirculation)CardiacandRespiratoryFailureSymptomaticPEShortofBreathAsymptomaticPEPulmonaryArteryHypertensionComplication for DVTPhl

50、egmasiaCeruleaDolens(BlueLegs):股青肿静脉血栓早期时严重的肢体肿胀肢体张力极度增高肢体动脉受压和痉挛缺血坏死Complication for DVTUltrasound/Venography：了解血栓部位及范围了解血栓部位及范围、对侧肢体有无血栓、对侧肢体有无血栓 CTA:怀疑有肺动脉栓塞怀疑有肺动脉栓塞（PulmonaryEmbolism,PE）Examination for DVTInitial Treatment of DVTMobilization and Leg ElevationAnticoagulation:普通肝素1000U/h静脉泵入低分子肝素0

51、.4mlq12hiH47天+华法林2.5mgqdINR：2.0-2.5口服华法令:36月发病危险因素不明确/长期存在DVT:口服华法令1年甚至终生Thrombolysis 溶栓：尿激酶或重组链激酶 50万U/天 静脉泵入 57天 根据凝血机制监测结果及临床表现的变化调整用量Indication for Vena Cava Filters：Repeated PE 反复发生肺栓塞 Float Thrombus 存在悬浮、游离的血栓Contraindicationstoanticoagulation抗凝禁忌 Blue Leg/Venous Thrombectomy 股青肿患者行手术取栓 Initia

52、l Prevention of Pulmonary Embolism 静脉血栓后期 静脉瓣膜破坏 静脉功能不全 继发性静脉曲张(20%30%)足靴区顽固性溃疡(3%5%)色素沉着 皮肤湿疹 溃疡疼痛 感染 影响生活质量Prevention and Treatment of Post-Thrombus SyndromePost-Thrombus Syndrome深静脉深静脉血栓后综合症血栓后综合症Prevention and Treatment of Post-Thrombus SyndromeAnticoagulation:Warfarin12monthsINR:22.5（2008指南）Elastic Stockings：坚持穿循序减压弹力袜（2007指南）静脉活性药物静脉活性药物：地奥斯明（爱脉朗）（2008指南）Thanks 谢谢！Email:,微信平台：华西血管微信平台：华西血管