Jobst Vascular Institute, Toledo, Ohio, USA.
J Vasc Surg. 2012 Jan;55(1):129-35. doi: 10.1016/j.jvs.2011.05.017. Epub 2011 Sep 3.
The postthrombotic syndrome is a debilitating condition occurring in 30% to 50% of patients with lower extremity deep vein thrombosis (DVT). Following iliofemoral DVT, however, postthrombotic morbidity is especially severe, due to occlusion of the common femoral vein (CFV) and iliac veins. While endoluminal recanalization appears effective in restoring patency to the iliac venous system, infrainguinal obstruction of the CFV remains a problem. The purpose of this study is to report preliminary observations of common femoral endovenectomy and intraoperative endoluminal recanalization of the iliac veins in patients with incapacitating postthrombotic iliofemoral obstruction.
Ten patients underwent common femoral endovenectomy with endoluminal iliocaval recanalization. The Venous Clinical Severity Score (VCSS), a validated tool to assess chronic venous disease, the Villalta scale, a validated tool to quantify postthrombotic syndrome, the clinical classification of CEAP, and the Venous Insufficiency Epidemiological and Economic Study-Quality of Life (VEINES-QOL)/Sym questionnaires were completed preoperatively and readministered postoperatively at 8.8 months (mean).
Five patients were followed for more than 6 months and form the basis of the long-term analysis. All demonstrated significant improvement in their venous scores postoperatively. The VCSS preoperatively was 17 and fell to 9.8 postoperatively (P = .02). The Villalta scale dropped from 13.6 preoperatively to 6.0 postoperatively (P = .002). The VEINES-QOL/Sym questionnaire, a sensitive marker of patient quality of life and symptom status, was improved (P = .01 and .02, respectively).
Chronic postthrombotic iliofemoral venous obstruction treated with common femoral endovenectomy and endoluminal recanalization improves objective outcome measures of patients with chronic postthrombotic obstruction. By restoring unobstructed venous drainage through the CFV to the vena cava, patients' postthrombotic morbidity is reduced and quality of life is improved.
血栓后综合征是一种使人虚弱的疾病，发生在下肢深静脉血栓形成（DVT）患者的 30%至 50%中。然而，在髂股静脉血栓形成（iliofemoral DVT）后，由于股总静脉（CFV）和髂静脉闭塞，血栓后发病率尤其严重。虽然腔内再通似乎有效地恢复了髂静脉系统的通畅性，但 CFV 的下肢静脉阻塞仍然是一个问题。本研究旨在报告在患有使人丧失能力的血栓后髂股静脉阻塞的患者中，进行股总静脉内膜切除术和髂静脉腔内再通术的初步观察结果。
10 名患者接受了股总静脉内膜切除术和髂腔静脉再通术。采用静脉临床严重程度评分（VCSS）、评估慢性静脉疾病的有效工具、血栓后综合征的有效评估工具 Villalta 评分、CEAP 临床分类和静脉功能不全流行病学和经济研究-生活质量（VEINES-QOL）/症状问卷进行术前和术后 8.8 个月（平均）的评估。
5 名患者的随访时间超过 6 个月，是长期分析的基础。所有患者术后静脉评分均显著改善。术前 VCSS 为 17 分，术后降至 9.8 分（P=0.02）。Villalta 评分从术前 13.6 分降至术后 6.0 分（P=0.002）。VEINES-QOL/Sym 问卷是患者生活质量和症状状况的敏感标志物，也得到了改善（分别为 P=0.01 和 P=0.02）。
采用股总静脉内膜切除术和腔内再通术治疗慢性血栓后髂股静脉阻塞可改善慢性血栓后阻塞患者的客观预后指标。通过恢复 CFV 向腔静脉的通畅无阻的静脉引流，减轻了患者的血栓后发病率，提高了生活质量。
