非血栓性髂静脉狭窄支架成形术对深静脉瓣膜功能的影响
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摘要
目的探讨髂静脉支架成形术对非血栓性髂静脉压迫病变(NIVCL)患者深静脉瓣膜功能的影响。方法收集2015年4月～2018年4月我院血管外科22例行髂静脉支架成形术治疗的NIVCL合并下肢深静脉瓣膜反流患者的临床资料及随访结果,其中21例左侧髂静脉狭窄,1例右侧髂静脉狭窄,比较患者手术前后深静脉瓣膜反流持续时间(VCT)及静脉疾病严重程度评分(VCSS)。结果 22例患者手术均成功,成功率100.00%,术后无支架闭塞、下肢感染和深静脉血栓形成等严重并发症。术后3个月随访时,一期支架通畅率100.00%,肿胀缓解率83.30%,溃疡愈合率80.00%。患者术后3个月VCT较术前减少[(1.68±1.67)s vs(2.46±1.36)s],差异有统计学意义(P<0.05);术后3个月VCSS评分较术前降低[(5.00±1.54)分vs(5.59±2.13)分],差异有统计学意义(P<0.05)。结论髂静脉支架成形术是NIVCL安全、有效的治疗方法,对轻度深静脉瓣膜功能不全有明显改善作用。
Objective To investigate the effect of iliac vein stenting on deep venous valve function in patients with non-thrombotic iliac vein compression(NIVCL).Methods From April 2015 to April 2018, 22 patients with vascular surgery in our hospital underwent iliac vein stenting for clinical data and follow-up of NIVCL with deep venous valve regurgitation. 21 patients had left iliac vein stenosis. One patient had a right iliac vein stenosis. The duration of deep venous regurgitation(VCT) and venous disease severity score(VCSS) were compared before and after surgery. Results All the 22 patients were successfully operated with a success rate of 100.00%. There were no serious complications such as stent occlusion, lower limb infection and deep vein thrombosis. At 3 months follow-up, the first-stage stent patency rate was 100.00%, the swelling relief rate was 83.30%, and the ulcer healing rate was 80.00%. The VCT of the patients decreased 3 months after operation [(1.68 ±1.67) s vs(2.46±1.36) s], the difference was statistically significant(P <0.05); the VCSS score decreased 3 months after surgery [(5.00 ±1.54) score vs(5.59 ±2.13)score], the difference was statistically significant(P<0.05).Conclusion The iliac vein stenting is a safe and effective treatment for NIVCL, which has a significant improvement on mild deep venous insufficiency.
Objective To investigate the effect of iliac vein stenting on deep venous valve function in patients with non-thrombotic iliac vein compression(NIVCL).Methods From April 2015 to April 2018, 22 patients with vascular surgery in our hospital underwent iliac vein stenting for clinical data and follow-up of NIVCL with deep venous valve regurgitation. 21 patients had left iliac vein stenosis. One patient had a right iliac vein stenosis. The duration of deep venous regurgitation(VCT) and venous disease severity score(VCSS) were compared before and after surgery. Results All the 22 patients were successfully operated with a success rate of 100.00%. There were no serious complications such as stent occlusion, lower limb infection and deep vein thrombosis. At 3 months follow-up, the first-stage stent patency rate was 100.00%, the swelling relief rate was 83.30%, and the ulcer healing rate was 80.00%. The VCT of the patients decreased 3 months after operation [(1.68 ±1.67) s vs(2.46±1.36) s], the difference was statistically significant(P <0.05); the VCSS score decreased 3 months after surgery [(5.00 ±1.54) score vs(5.59 ±2.13)score], the difference was statistically significant(P<0.05).Conclusion The iliac vein stenting is a safe and effective treatment for NIVCL, which has a significant improvement on mild deep venous insufficiency.
引文
[1]Mahnken AH,Thomson K,Haan M,et al.CIRSE standardso practice guidelines on iliocaval stenting[J].CardiovascInterventRadiol,2014,37(4):889-897.
[2]Shi WY,Gu JP,Liu CJ,et al.Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis:A retrospective study on mid-term instent patency from a single center[J].European Journal of Radiology,2016,85(1):7.
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[4]Seshadri Raju,Matthew Oglesbee,Peter Neglén.Iliac vein stenting in postmenopausal leg swelling[J].Journal of Vascular Surgery,2011,53(1):123-130.
[5]Lee KM,Park JK,Lim SH,et al.May-Thurner syndrome found incidentally after left femoral catheterization in a pediatric patient[J].Pediatric Blood&Cancer,2010,55(6):1191-1194.
[6]Huang C,Yu G.Midterm Results of Endovascular Treatment for Iliac Vein Compression Syndrome from a Single Center[J].Ann Vasc Surg,2018(49):57-63.
[7]Brinegar KN,Sheth RA,Khademhosseini A,et al.Iliac vein compression syndrome:Clinical,imaging and pathologic findings[J].World J Radiol,2015,7(11):375-381.
[8]Sista AK,Vedantham S,Kaufman JA,et al.Endovascularinterventions for acute and chronic lower extremity deep venous disease:state of the art[J].Radiology,2015,276(1):31-53.
[9]Ahmed O,Ng J,Patel M,et al.Endovascular stent placement forMay-Thurner syndrome in the absence of acute deep vein thrombosis[J].J Vasc Interv Radiol,2016,27(2):167-173.
[10]Goldman RE,Arendt VA,Kothary N,et al.Endovascularmanagement of May-Thurner syndrome in adolescents:Asinglecenter experience[J].J Vasc Interv Radiol,2017,28(1):71-77.
[11]Rizvi SA,Ascher E,Hingorani A,et al.Stent patency in patients with advanced chronic venous disease and nonthrombotic iliac vein lesions[J].Journal of Vascular Surgery Venous&Lymphatic Disorders,2016,4(1):151.
[12]李晓强,李承龙.非血栓性髂静脉受压综合征诊治的问题与讨论[J].中华血管外科杂志,2016,1(1):13-15.
[13]Mahnken AH,Thomson K,de Haan M,et al.CIRSE standardsof practice guidelines on iliocaval stenting[J].Cardiovasc Intervent Radiol,2014,37(4):889-897.
[14]Raju S.Best management options for chronic iliac vein stenosis and occlusion[J].Journal of Vascular Surgery,2013,57(4):1163-1169.
[15]Kearon C,Akl EA,Comerota AJ,et al.Antithrombotic therapy for VTE disease:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2):e278S.
[2]Shi WY,Gu JP,Liu CJ,et al.Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis:A retrospective study on mid-term instent patency from a single center[J].European Journal of Radiology,2016,85(1):7.
[3]Cronenwett JL,Johnston KW.Chronic Venous Insufficiency:Deep Vein Valve Reconstruction[A]//Rutherford RB Jr,Cronenwett JL,Johnston W.Rutherford's Vascular Surgery[M].8th Ed.W.B.Saunders Company,2014:914-927.
[4]Seshadri Raju,Matthew Oglesbee,Peter Neglén.Iliac vein stenting in postmenopausal leg swelling[J].Journal of Vascular Surgery,2011,53(1):123-130.
[5]Lee KM,Park JK,Lim SH,et al.May-Thurner syndrome found incidentally after left femoral catheterization in a pediatric patient[J].Pediatric Blood&Cancer,2010,55(6):1191-1194.
[6]Huang C,Yu G.Midterm Results of Endovascular Treatment for Iliac Vein Compression Syndrome from a Single Center[J].Ann Vasc Surg,2018(49):57-63.
[7]Brinegar KN,Sheth RA,Khademhosseini A,et al.Iliac vein compression syndrome:Clinical,imaging and pathologic findings[J].World J Radiol,2015,7(11):375-381.
[8]Sista AK,Vedantham S,Kaufman JA,et al.Endovascularinterventions for acute and chronic lower extremity deep venous disease:state of the art[J].Radiology,2015,276(1):31-53.
[9]Ahmed O,Ng J,Patel M,et al.Endovascular stent placement forMay-Thurner syndrome in the absence of acute deep vein thrombosis[J].J Vasc Interv Radiol,2016,27(2):167-173.
[10]Goldman RE,Arendt VA,Kothary N,et al.Endovascularmanagement of May-Thurner syndrome in adolescents:Asinglecenter experience[J].J Vasc Interv Radiol,2017,28(1):71-77.
[11]Rizvi SA,Ascher E,Hingorani A,et al.Stent patency in patients with advanced chronic venous disease and nonthrombotic iliac vein lesions[J].Journal of Vascular Surgery Venous&Lymphatic Disorders,2016,4(1):151.
[12]李晓强,李承龙.非血栓性髂静脉受压综合征诊治的问题与讨论[J].中华血管外科杂志,2016,1(1):13-15.
[13]Mahnken AH,Thomson K,de Haan M,et al.CIRSE standardsof practice guidelines on iliocaval stenting[J].Cardiovasc Intervent Radiol,2014,37(4):889-897.
[14]Raju S.Best management options for chronic iliac vein stenosis and occlusion[J].Journal of Vascular Surgery,2013,57(4):1163-1169.
[15]Kearon C,Akl EA,Comerota AJ,et al.Antithrombotic therapy for VTE disease:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2):e278S.