腔内治疗髂静脉受压综合征伴与不伴下肢深静脉血栓效果比较
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摘要
目的评估腔内治疗髂静脉受压综合征(IVCS)伴与不伴下肢深静脉血栓形成(DVT)效果差异。方法回顾性分析2014年1月至2016年12月经下肢静脉造影确诊并经血管腔内治疗的148例IVCS患者临床资料。根据是否伴发DVT,分为非血栓性IVCS(NIVCS组,n=81)、血栓性IVCS(TIVCS组,n=67)。术后随访患肢症状改善情况及髂静脉通畅性。结果 148例患者中4例接受单纯经皮腔内血管成形术(PTA),141例接受PTA+支架植入术,3例手术失败,技术成功率为97.97%(145/148)。术后并发症发生率为9.46%(14/148),无严重并发症发生。NIVCS组63例术后3～6个月接受二期大隐静脉高位结扎+曲张静脉腔内激光闭合术均获成功。术后NIVCS组、TIVCS组患者症状均得到缓解,腔内治疗有效率分别为97.53%、94.03%(P=0.410)、髂静脉通畅率分别为96.30%、91.04%(P=0.316)。平均随访15.6(6～30)个月,TIVCS组有2例DVT复发,NIVCS组无静脉曲张复发;NIVCS组、TIVCS组患者腔内治疗有效率分别为95.59%、90.90%(P=0.465),但NIVCS组髂静脉通畅率明显高于TIVCS组(92.65%对80.00%,P=0.038)。结论腔内治疗IVCS患者效果良好,并发症少。血栓性IVCS患者腔内治疗的中远期髂静脉通畅率低于非血栓性IVCS患者。
Objective To compare the effect of endovascular therapy for iliac vein compression syndrome(IVCS) with deep venous thrombosis(DVT) of lower limb with that for IVCS without DVT of lower limb. Methods The clinical data of 148 patients with lower limb venography-proved IVCS, who were admitted to authors' hospital during the period from January 2014 to December 2016 to receive endovascular therapy, were retrospectively analyzed. According to whether IVCS was accompanied by DVT, the patients were divided into non-thrombotic IVCS group(NIVCS group, n=81) and thrombotic IVCS group(TIVCS group, n =67). After endovascular treatment, all patients were followed up to assess the improvement of symptoms of affected limb and to check the patency of iliac vein. Results Of the 148 patients, pure percutaneous transluminal angioplasty(PTA) was employed in 4, PTA together with stent implantation was adopted in 141, and the operation failed in 3. The technical success rate was 97.97%(145/148). The incidence of postoperative complications was 9.46%(14/148), no severe complications occurred. Sixty-three patients in NIVCS group received second-stage high-level ligation of great saphenous vein plus endovascular laser closure of varicose veins in 3-6 months after endovascular therapy, and the operation was successfully accomplished in all patients. After the treatment, the patient's symptoms were relieved in both groups. In NIVCS group and TIVCS group, the effective rates of endovascular therapy were 97.53% and 94.03%respectively(P=0.410), the patency rates of iliac vein were 96.30% and 91.04% respectively(P =0.316).The mean follow-up time was 15.6 months(6-30 months); 2 patients in TIVCS group developed recurrence of DVT and no recurrence of varicosity occurred in NIVCS group. The effective rates of endovascular therapy in NIVCS group and TIVCS group were 95.59% and 90.90% respectively(P=0.465), while the patency rate of iliac vein in NIVCS group was significantly higher than that in TIVCS group(92.65% vs 82.00%, P=0.038). Conclusion For the treatment of IVCS, endovascular therapy is very effective with less complications. The medium-to-long-term patency rate of iliac vein in patients with DVT is lower than that in patients with no DVT.
Objective To compare the effect of endovascular therapy for iliac vein compression syndrome(IVCS) with deep venous thrombosis(DVT) of lower limb with that for IVCS without DVT of lower limb. Methods The clinical data of 148 patients with lower limb venography-proved IVCS, who were admitted to authors' hospital during the period from January 2014 to December 2016 to receive endovascular therapy, were retrospectively analyzed. According to whether IVCS was accompanied by DVT, the patients were divided into non-thrombotic IVCS group(NIVCS group, n=81) and thrombotic IVCS group(TIVCS group, n =67). After endovascular treatment, all patients were followed up to assess the improvement of symptoms of affected limb and to check the patency of iliac vein. Results Of the 148 patients, pure percutaneous transluminal angioplasty(PTA) was employed in 4, PTA together with stent implantation was adopted in 141, and the operation failed in 3. The technical success rate was 97.97%(145/148). The incidence of postoperative complications was 9.46%(14/148), no severe complications occurred. Sixty-three patients in NIVCS group received second-stage high-level ligation of great saphenous vein plus endovascular laser closure of varicose veins in 3-6 months after endovascular therapy, and the operation was successfully accomplished in all patients. After the treatment, the patient's symptoms were relieved in both groups. In NIVCS group and TIVCS group, the effective rates of endovascular therapy were 97.53% and 94.03%respectively(P=0.410), the patency rates of iliac vein were 96.30% and 91.04% respectively(P =0.316).The mean follow-up time was 15.6 months(6-30 months); 2 patients in TIVCS group developed recurrence of DVT and no recurrence of varicosity occurred in NIVCS group. The effective rates of endovascular therapy in NIVCS group and TIVCS group were 95.59% and 90.90% respectively(P=0.465), while the patency rate of iliac vein in NIVCS group was significantly higher than that in TIVCS group(92.65% vs 82.00%, P=0.038). Conclusion For the treatment of IVCS, endovascular therapy is very effective with less complications. The medium-to-long-term patency rate of iliac vein in patients with DVT is lower than that in patients with no DVT.
引文
[1]吴霜,顾建平,楼文胜.髂静脉受压综合征病因及诊疗研究进展[J].介入放射学杂志,2015,24:733-737.
[2]李晓强,钱爱民.髂静脉受压综合征的诊断和治疗[J].中国血管外科杂志·电子版,2013,5:6-8.
[3]Raju S,Neglen P.High prevalence of nonthrombotic iliac vein lesions in chronic venous disease:a permissive role in pathogenicity[J].J Vasc Surg,2006,44:136-143.
[4]Xue GH,Huang XZ,Ye M,et al.Catheter-directed thrombolysis and stenting in the treatment of iliac vein compression syndrome with acute iliofemoral deep vein thrombosis:outcome and followup[J].Ann Vasc Surg,2014,28:957-963.
[5]Bkgaard N,Just S,Foegh P.Which criteria demand additive stenting during catheter-directed thrombolysis?[J].Phlebology,2014,29:112-118.
[6]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 in-stent patency from a single center[J].Eur J Radiol,2016,85:7-14.
[7]Liu ZJ,Gao N,Shen LG,et al.Endovascular treatment for symptomatic iliac vein compression syndrome:a prospective consecutive series of 48 patients[J].Ann Vasc Surg,2014,28:695-704.
[8]沈莉,顾建平.髂静脉受压综合征的影像诊断进展[J].介入放射学杂志,2010,19:75-78.
[9]张玉超,李维敏,黄英,等.腔内介入治疗髂静脉受压综合征[J].中国血管外科杂志·电子版,2013,5:35-37.
[10]唐博,罗文军,孙建明,等.腔内激光联合手术治疗下肢静脉曲张243例:中长期临床效果分析[J].激光杂志,2008,29:83-84.
[11]Zhang X,Ren Q,Jiang X,et al.A prospective randomized trial of catheter-directed thrombolysis with additional balloon dilatation for iliofemoral deep venous thrombosis:a single-center experience[J].Cardiovasc Intervent Radiol,2014,37:958-968.
[12]Lou WS,Gu JP,He X,et al.Endovascular treatment for iliac vein compression syndrome:a comparison between the presence and absence of secondary thrombosis[J].Korean J Radiol,2009,10:135-143.
[13]赵军.腔内治疗髂静脉压迫综合征的初步体会(附26例报告)[J].心肺血管病杂志,2011,30:467-470.
[14]赵渝,李德卫,时德,等.髂静脉受压综合征的解剖基础[J].中国实用外科杂志,2003,23:745-746.
[15]葛世堂,潘晓琳,张希全,等.血管腔内介入治疗髂静脉压迫综合征并急性髂股静脉血栓疗效观察[J].中华实用诊断与治疗杂志,2015,29:692-694.
[16]王利新,符伟国.腔内超声在髂静脉受压综合征腔内治疗中的应用价值[J].血管与腔内血管外科杂志,2015,1:16-19.
[17]Carr S,Chan K,Rosenberg J,et al.Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis[J].J Vasc Interv Radiol,2012,23:1467-1472.
[18]Mahnken AH,Thomson K,De Haan MA.CIRSE standards of practice guidelines on iliocaval stenting[J].Cardiovasc Intervent Radiol,2014,37:889-897.
[19]樊宝瑞,金泳海,段鹏飞,等.同期血栓机械清除联合髂静脉支架植入治疗急性下肢深静脉血栓形成12例[J].介入放射学杂志,2017,26:60-64.
[20]Alhadad A,Kolbel T,Herbst A,et al.Iliocaval vein stenting:Long term survey of postthrombotic symptoms and working capacity[J].J Thromb Thrombolysis,2011,31:211-216.
[21]朱亮,张希全,孙业全,等.急性全下肢深静脉血栓形成多种介入技术联合治疗[J].介入放射学杂志,2013,22:582-586.
[22]李维敏,陆信武.非血栓性髂静脉受压综合征介入治疗并发症的防治[J].医学研究杂志,2011,40:88-90.
[23]虞丰,李晓强.髂静脉受压综合征腔内治疗并发症原因分析及防治[J].中国血管外科杂志·电子版,2015,7:256-258.
[24]Buccheri D,Piraino D,Andolina G,et al.Understanding and managing in-stent restenosis:a review of clinical data,from pathogenesis to treatment[J].J Thorac Dis,2016,8:E1150-E1162.
[25]Knipp BS,Ferguson E,Williams DM,et al.Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome[J].J Vasc Surg,2007,46:743-749.
[26]Neglen P,Hollis KC,Olivier J,et al.Stenting of the venous outflow in chronic venous disease:long-term stent-related outcome,clinical,and hemodynamic result[J].J Vasc Surg,2007,46:979-990.
[27]Mousa AY,Aburahma AF.May-Thurner syndrome:update and review[J].Ann Vasc Surg,2013,27:984-995.
[28]Vazquez-Garza E,Jerjes-Sanchez C,Navarrete A,et al.Venous thromboembolism:thrombosis,inflammation,and immunothrombosis for clinicians[J].J Thromb Thrombolysis,2017,44:377-385.
[29]Kundi H.Association of novel inflammatory and oxidative stress biomarkers with in-stent restenosis[J].Angiology,2017,68:832.
[30]Neglen P,Raju S.In-stent recurrent stenosis in stents placed in the lower extremity venous outflow tract[J].J Vasc Surg,2004,39:181-187.
[2]李晓强,钱爱民.髂静脉受压综合征的诊断和治疗[J].中国血管外科杂志·电子版,2013,5:6-8.
[3]Raju S,Neglen P.High prevalence of nonthrombotic iliac vein lesions in chronic venous disease:a permissive role in pathogenicity[J].J Vasc Surg,2006,44:136-143.
[4]Xue GH,Huang XZ,Ye M,et al.Catheter-directed thrombolysis and stenting in the treatment of iliac vein compression syndrome with acute iliofemoral deep vein thrombosis:outcome and followup[J].Ann Vasc Surg,2014,28:957-963.
[5]Bkgaard N,Just S,Foegh P.Which criteria demand additive stenting during catheter-directed thrombolysis?[J].Phlebology,2014,29:112-118.
[6]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 in-stent patency from a single center[J].Eur J Radiol,2016,85:7-14.
[7]Liu ZJ,Gao N,Shen LG,et al.Endovascular treatment for symptomatic iliac vein compression syndrome:a prospective consecutive series of 48 patients[J].Ann Vasc Surg,2014,28:695-704.
[8]沈莉,顾建平.髂静脉受压综合征的影像诊断进展[J].介入放射学杂志,2010,19:75-78.
[9]张玉超,李维敏,黄英,等.腔内介入治疗髂静脉受压综合征[J].中国血管外科杂志·电子版,2013,5:35-37.
[10]唐博,罗文军,孙建明,等.腔内激光联合手术治疗下肢静脉曲张243例:中长期临床效果分析[J].激光杂志,2008,29:83-84.
[11]Zhang X,Ren Q,Jiang X,et al.A prospective randomized trial of catheter-directed thrombolysis with additional balloon dilatation for iliofemoral deep venous thrombosis:a single-center experience[J].Cardiovasc Intervent Radiol,2014,37:958-968.
[12]Lou WS,Gu JP,He X,et al.Endovascular treatment for iliac vein compression syndrome:a comparison between the presence and absence of secondary thrombosis[J].Korean J Radiol,2009,10:135-143.
[13]赵军.腔内治疗髂静脉压迫综合征的初步体会(附26例报告)[J].心肺血管病杂志,2011,30:467-470.
[14]赵渝,李德卫,时德,等.髂静脉受压综合征的解剖基础[J].中国实用外科杂志,2003,23:745-746.
[15]葛世堂,潘晓琳,张希全,等.血管腔内介入治疗髂静脉压迫综合征并急性髂股静脉血栓疗效观察[J].中华实用诊断与治疗杂志,2015,29:692-694.
[16]王利新,符伟国.腔内超声在髂静脉受压综合征腔内治疗中的应用价值[J].血管与腔内血管外科杂志,2015,1:16-19.
[17]Carr S,Chan K,Rosenberg J,et al.Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis[J].J Vasc Interv Radiol,2012,23:1467-1472.
[18]Mahnken AH,Thomson K,De Haan MA.CIRSE standards of practice guidelines on iliocaval stenting[J].Cardiovasc Intervent Radiol,2014,37:889-897.
[19]樊宝瑞,金泳海,段鹏飞,等.同期血栓机械清除联合髂静脉支架植入治疗急性下肢深静脉血栓形成12例[J].介入放射学杂志,2017,26:60-64.
[20]Alhadad A,Kolbel T,Herbst A,et al.Iliocaval vein stenting:Long term survey of postthrombotic symptoms and working capacity[J].J Thromb Thrombolysis,2011,31:211-216.
[21]朱亮,张希全,孙业全,等.急性全下肢深静脉血栓形成多种介入技术联合治疗[J].介入放射学杂志,2013,22:582-586.
[22]李维敏,陆信武.非血栓性髂静脉受压综合征介入治疗并发症的防治[J].医学研究杂志,2011,40:88-90.
[23]虞丰,李晓强.髂静脉受压综合征腔内治疗并发症原因分析及防治[J].中国血管外科杂志·电子版,2015,7:256-258.
[24]Buccheri D,Piraino D,Andolina G,et al.Understanding and managing in-stent restenosis:a review of clinical data,from pathogenesis to treatment[J].J Thorac Dis,2016,8:E1150-E1162.
[25]Knipp BS,Ferguson E,Williams DM,et al.Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome[J].J Vasc Surg,2007,46:743-749.
[26]Neglen P,Hollis KC,Olivier J,et al.Stenting of the venous outflow in chronic venous disease:long-term stent-related outcome,clinical,and hemodynamic result[J].J Vasc Surg,2007,46:979-990.
[27]Mousa AY,Aburahma AF.May-Thurner syndrome:update and review[J].Ann Vasc Surg,2013,27:984-995.
[28]Vazquez-Garza E,Jerjes-Sanchez C,Navarrete A,et al.Venous thromboembolism:thrombosis,inflammation,and immunothrombosis for clinicians[J].J Thromb Thrombolysis,2017,44:377-385.
[29]Kundi H.Association of novel inflammatory and oxidative stress biomarkers with in-stent restenosis[J].Angiology,2017,68:832.
[30]Neglen P,Raju S.In-stent recurrent stenosis in stents placed in the lower extremity venous outflow tract[J].J Vasc Surg,2004,39:181-187.