不同类型Cockett综合征腔内治疗临床疗效分析
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摘要
目的对不同类型Cockett综合征的腔内治疗的疗效分析。方法 2011年8月~2014年2月,对25例Cockett综合征患者根据不同阶段、不同类型及其病变程度给予腔内血管重建。25例患者中,6例患者(髂静脉狭窄大于30%,小于80%侧支循环欠佳,无下肢深静脉血栓形成)给予单纯球扩成形术,17例患者(髂静脉狭窄大于30%合并急性期左下肢深静脉血栓形成)给予置管溶栓后给予髂静脉成形术,2例患者(小于80%侧支循环欠佳下肢静脉性淤血较重或髂静脉狭窄大于80%,合并皮炎及溃疡等)给予球扩成型后支架植入术。结果手术成功率为100%,共植入3枚自膨式血管支架。随访时间为3~39个月,平均16.3个月。采用生活质量调查问卷形式对患者进行评价,23例患者符合治愈标准;1例患者符合治疗好转标准,1例因未规律口服抗凝药物复发。结论不同阶段Cockett综合征的腔内积极治疗是必要的,对其导致的下肢慢性静脉功能不全、下肢深静脉血栓形成及血栓后遗症等的预防及治疗有积极意义。
Objective To evaluate the therapeutic efficacy of endovascular treatment in different types of the Cockett syndrome. Methods 25 patients with Cockett syndrome were treated with endovascular reconstruction from August 2011 to February 2014 according to the different stages, types and severity degree of the desease. Among them, six(whose iliac vein stenosis is over 30 %, poor collateral circulation is less than 80 % with no deep venous thrombosis in lower limbs) were given endovascular revascularization therapy. Seventeen(whose iliac vein stenosis is over 30% with deep venous thrombosis in the left lower limb in merge acute stage) were treated with endovascular revascularization after catheter-directed thrombolysis. Two(whose poor collateral circulation and heavy venous congestion in lower limbs is less than 80 %, iliac vein stenosis is over 80 % with merge dermatitis and ulceration) were given self-expandable stents after endovascular revas-cularization. Results The successful rate of this therapy was 100%, and 3 self-expandable stents were implanted in total. All cases were followed-up for 3 to 39 months(mean, 16.3 months). Questionares about living quality were given to those previous patients and the findings: 23 of them meet the cure standards; 1 patient was getting better; 1 patient relapsed because of not taking anticoagulant regularly.Conclusion The endovascular treatment of Cockett syndrome in different stages is indispensable, for it has great positive significance to the prevention and treatment of restenosis, DVT and PTS.
Objective To evaluate the therapeutic efficacy of endovascular treatment in different types of the Cockett syndrome. Methods 25 patients with Cockett syndrome were treated with endovascular reconstruction from August 2011 to February 2014 according to the different stages, types and severity degree of the desease. Among them, six(whose iliac vein stenosis is over 30 %, poor collateral circulation is less than 80 % with no deep venous thrombosis in lower limbs) were given endovascular revascularization therapy. Seventeen(whose iliac vein stenosis is over 30% with deep venous thrombosis in the left lower limb in merge acute stage) were treated with endovascular revascularization after catheter-directed thrombolysis. Two(whose poor collateral circulation and heavy venous congestion in lower limbs is less than 80 %, iliac vein stenosis is over 80 % with merge dermatitis and ulceration) were given self-expandable stents after endovascular revas-cularization. Results The successful rate of this therapy was 100%, and 3 self-expandable stents were implanted in total. All cases were followed-up for 3 to 39 months(mean, 16.3 months). Questionares about living quality were given to those previous patients and the findings: 23 of them meet the cure standards; 1 patient was getting better; 1 patient relapsed because of not taking anticoagulant regularly.Conclusion The endovascular treatment of Cockett syndrome in different stages is indispensable, for it has great positive significance to the prevention and treatment of restenosis, DVT and PTS.
引文
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[11]Igari K,Kudo T,Toyofuku T,et al.Surgical Thrombectomy and Simultaneous Stenting for Deep Venous Thrombosis Caused by Iliac Vein Compression Syndrome(May-Thurner Syndrome)[J].Ann Thorac Cardiovasc Surg,2014,20(6):995-1000.
[12]Zhu QH,Zhou CY,Chen Y,et al.Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis:a prospective study of single-session endovascular protocol[J].Eur J Vasc Endovasc Surg,2014,47(1):68-74.
[13]Park SI,Lee M,Lee MS,et al.Single-session aspiration thrombectomy of lower extremity deep vein thrombosis using large-size catheter without pharmacologic thrombolysis[J].Cardiovasc Intervent Radiol,2014,37(2):412-409.
[14]刘鹏,陈洁,叶志东,等.手术取栓联合腔内介入治疗Cockett综合征并发急性深静脉血栓的临床疗效分析[J].中国血管外科杂志(电子版),2013,5(1):31-34.
[15]冯琦琛,李选,李天润,等.合并Cockett综合征的急性下肢深静脉血栓形成患者髂静脉扩张成形时机对导管直接溶栓持续时间的影响[J].中国微创外科杂志,2013,13(2):116-118,126.
[16]Park JY,Ahn JH,Jeon YS,et al.Iliac vein stenting as a durable option for residual stenosis after catheterdirected thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome[J].Phlebology,2013,29(7):461-470.
[17]Baekgaard N,Broholm R,Just S.Indications for stenting during thrombolysis[J].Phlebology,2013,28(1):112-116.
[18]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(1):6-8.
[19]te RWW,Overtoom TT,van den Berg JC,et al.Endovascular recanalization of chronic long-segment occlusions of the inferior vena cava:midterm results[J].J Endovasc Ther,2006,13(2):249-253.
[20]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(5):979-990.
[21]Butros SR,Liu R,Oliveira GR,et al.Venous compression syndromes:clinical features,imaging findings and management[J].Br J Radiol,2013,86(1030):312-314.
[2]Mousa AY,Abu Rahma AF.May-Thurner syndrome:update and review[J].Ann Vasc Surg,2013,27(7):984-995.
[3]Pandit AS,Hayes M,Guiney-Borgelt S,et al.Iatrogenic May-Thurner syndrome after EVAR[J].Ann Vasc Surg,2014,28(3):739.e17-20.
[4]Rege AS,Rendell VR,Shrimal A,et al.May-Thurner syndrome complicating left-sided donor nephrectomy[J].Transplantation,2014,97(7):e40-41.
[5]Wax JR,Pinette MG,Rausch D,Cartin A.May-Thurner syndrome complicating pregnancy:a report of four cases[J].J Reprod Med,2014,59(56):333-336.
[6]Mathur M,Cohen M,Bashir R.May-Thurner syndrome[J].Circulation,2014,129(7):824-825.
[7]Lu T,de Grandis E,Gloviczki P,et al.May-Thurner syndrome associated with Klippel-Trenaunay syndrome[J].Perspect Vasc Surg Endovasc Ther,2012,24(3):155-160.
[8]Sadaghianloo N,Jean-Baptiste E,Haudebourg P,et al.Successful treatment of a spontaneous rupture of the left external iliac vein in a man[J].Vascular,2014,22(1):68-70.
[9]宋燕,王子凡,郭学利.下肢深静脉血栓手术取栓术中Cockett综合征的处理(附173例报告)[J].医学信息(手术学分册),2007,20(4):304-306.
[10]Lamba R,Tanner DT,Sekhon S,et al.Multidetector CT of vascular compression syndromes in the abdomen and pelvis[J].Radiographics,2014,34(1):4-6.
[11]Igari K,Kudo T,Toyofuku T,et al.Surgical Thrombectomy and Simultaneous Stenting for Deep Venous Thrombosis Caused by Iliac Vein Compression Syndrome(May-Thurner Syndrome)[J].Ann Thorac Cardiovasc Surg,2014,20(6):995-1000.
[12]Zhu QH,Zhou CY,Chen Y,et al.Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis:a prospective study of single-session endovascular protocol[J].Eur J Vasc Endovasc Surg,2014,47(1):68-74.
[13]Park SI,Lee M,Lee MS,et al.Single-session aspiration thrombectomy of lower extremity deep vein thrombosis using large-size catheter without pharmacologic thrombolysis[J].Cardiovasc Intervent Radiol,2014,37(2):412-409.
[14]刘鹏,陈洁,叶志东,等.手术取栓联合腔内介入治疗Cockett综合征并发急性深静脉血栓的临床疗效分析[J].中国血管外科杂志(电子版),2013,5(1):31-34.
[15]冯琦琛,李选,李天润,等.合并Cockett综合征的急性下肢深静脉血栓形成患者髂静脉扩张成形时机对导管直接溶栓持续时间的影响[J].中国微创外科杂志,2013,13(2):116-118,126.
[16]Park JY,Ahn JH,Jeon YS,et al.Iliac vein stenting as a durable option for residual stenosis after catheterdirected thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome[J].Phlebology,2013,29(7):461-470.
[17]Baekgaard N,Broholm R,Just S.Indications for stenting during thrombolysis[J].Phlebology,2013,28(1):112-116.
[18]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(1):6-8.
[19]te RWW,Overtoom TT,van den Berg JC,et al.Endovascular recanalization of chronic long-segment occlusions of the inferior vena cava:midterm results[J].J Endovasc Ther,2006,13(2):249-253.
[20]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(5):979-990.
[21]Butros SR,Liu R,Oliveira GR,et al.Venous compression syndromes:clinical features,imaging findings and management[J].Br J Radiol,2013,86(1030):312-314.