Wahlgren Carl-Magnus, Wahlberg Eric, Olofsson Pär
Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
Vasc Endovascular Surg. 2010 Jul;44(5):356-60. doi: 10.1177/1538574410369710. Epub 2010 May 18.
The postthrombotic syndrome is a chronic complication of deep venous thrombosis that leads to considerable pain and suffering to patients. We evaluated our experience of endovascular treatment for patients with chronic postthrombotic femoroiliocaval venous disease.
From January 2003 through December 2007, 50 patients (51 limbs; 60% women; mean age 45 years; range: 24-74 years) with chronic postthrombotic venous disease were referred to our institution for interventional assessment. All patients underwent duplex ultrasonography as well as ascending and descending venography. The CEAP (clinical, etiologic, anatomic, and pathophysiologic classification) clinical scores were class 0 (no signs) in 2% of limbs, class 3 (edema) in 63%, class 4a (pigmentation or eczema) in 18%, class 5 (healed venous ulcer) in 14%, and class 6 (active venous ulcer) in 4%. The etiology was secondary (postthrombotic) in all patients. The anatomical distribution of reflux and obstruction were deep veins in 63% and a combination of deep and superficial veins in 37%. The underlying pathophysiology due to obstruction of the deep venous outflow with no reflux was found in 25% of limbs, only reflux was found in 14%, and a combination of obstruction and reflux was found in 61%.
There were 21 limbs in 20 (38%) patients that underwent endovascular and/or surgical treatment. One limb underwent femoral endovenectomy and 1 limb superficial femoral vein to deep femoral vein transposition. In all, 19 limbs were scheduled for endovascular treatment. The technical success rate was 84%, 3 limbs with iliac vein occlusions could not be recanalized. A total of 11 patients (11 limbs) underwent solely endovascular intervention and 4 patients (5 limbs) underwent endovascular intervention combined with femoral endovenectomy. The endovascular and surgical procedures were performed with no perioperative or postoperative mortality as well as no major bleeding or cardiac, pulmonary, or renal 30-day complications. Early thrombosis (<30 days) of the stented iliac veins occurred in 3 limbs which were lysed and restented successfully. The mean follow-up time was 23 months (range: 1-69 months). Primary and assisted-primary/secondary patency rates at 12 months were 61% and 81%, respectively. The Venous Clinical Severity score was 9.1 (range: 5-15) before endovascular treatment and 6.0 (range: 3-13) after the treatment (P < .0001). There were 30 patients (62%) with symptoms attributable to venous dysfunction or with deep venous pathology that did not undergo interventional treatment after workup. These patients continued with appropriate thromboprophylaxis and elastic compression stockings.
Endovascular treatment of chronic postthrombotic femoroiliocaval venous disease is a safe technique that can be performed with acceptable patency rates in this challenging patient population.
血栓形成后综合征是深静脉血栓形成的一种慢性并发症，给患者带来极大的痛苦。我们评估了对慢性血栓形成后股髂腔静脉疾病患者进行血管内治疗的经验。
2003年1月至2007年12月，50例（51条肢体；60%为女性；平均年龄45岁；范围：24 - 74岁）慢性血栓形成后静脉疾病患者被转诊至我院进行介入评估。所有患者均接受了双功超声检查以及上行和下行静脉造影。CEAP（临床、病因、解剖和病理生理分类）临床评分中，2%的肢体为0级（无体征），63%为3级（水肿），18%为4a级（色素沉着或湿疹），14%为5级（愈合的静脉溃疡），4%为6级（活动性静脉溃疡）。所有患者的病因均为继发性（血栓形成后）。反流和阻塞的解剖分布中，63%为深静脉，37%为深静脉与浅静脉合并存在。25%的肢体发现深静脉流出道阻塞且无反流的潜在病理生理情况，14%仅发现反流，61%发现阻塞与反流并存。
20例（38%）患者的21条肢体接受了血管内和/或手术治疗。1条肢体接受了股静脉内膜切除术，1条肢体进行了股浅静脉至股深静脉转位术。总共19条肢体计划进行血管内治疗。技术成功率为84%，3条髂静脉闭塞的肢体未能再通。共有11例患者（11条肢体）仅接受了血管内干预，4例患者（5条肢体）接受了血管内干预联合股静脉内膜切除术。血管内和外科手术均未出现围手术期或术后死亡，也未出现严重出血或心脏、肺部或肾脏30天并发症。3条支架置入的髂静脉发生了早期血栓形成（<30天），成功进行了溶栓和再次支架置入。平均随访时间为23个月（范围：1 - 69个月）。12个月时的原发性和辅助原发性/继发性通畅率分别为61%和81%。血管内治疗前静脉临床严重程度评分为9.1（范围：5 - 15），治疗后为6.0（范围：3 - 13）（P <.0001）。有30例患者（62%）因静脉功能障碍或深静脉病变出现症状，在检查后未接受介入治疗。这些患者继续进行适当的血栓预防并使用弹力压迫袜。
对慢性血栓形成后股髂腔静脉疾病进行血管内治疗是一种安全的技术，在这一具有挑战性的患者群体中可获得可接受的通畅率。
