Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL, USA.
AJR Am J Roentgenol. 2013 Jun;200(6):1358-64. doi: 10.2214/AJR.12.8938.
The purpose of this study is to report the 30-day morbidity and mortality associated with the endovascular diagnosis and management of chronic cerebrospinal venous insufficiency.
The medical records of 95 consecutive patients (60 women and 35 men) with a mean age of 48 years (age range, 25-66 years) who underwent diagnostic endovascular evaluation and intervention for chronic cerebrospinal venous insufficiency between June 2010 and September 2011 were reviewed retrospectively. All patients had a diagnosis of multiple sclerosis by McDonald criteria. Endovascular evaluation of the internal jugular and azygos veins was performed with digital subtraction venography and intravascular ultrasound. Indications for percutaneous transluminal angioplasty (PTA) were venographic findings of a greater than 50% diameter stenosis, the presence of reflux on digital subtraction venography, greater than 50% cross-sectional area stenosis by intravascular ultra-sound, or a finding of abnormal thick valves or webs by either method. The primary endpoint of this study was the 30-day mortality, and the secondary endpoint was the presence of major complications. Results are presented as means and percentages.
A total of 107 procedures were performed in 95 patients. Endovascular evaluation showed venous lesions requiring intervention in 90 of 95 patients (94.7%) and was negative in five of 95 patients (5.3%). A total of 193 venous lesions were treated; angioplasty was technically successful in 188 of 193 (97.4%) lesions. Internal jugular vein thrombosis after PTA was identified in three of 95 (3.2%) of the treated patients. Bleeding at the puncture site not requiring transfusion occurred in four of 95 patients (4.2%). There were no reported procedure-related deaths.
The results of the current study suggest that endovascular evaluation and management of chronic cerebrospinal venous insufficiency is safe, with low morbidity and no procedure-related mortality.
本研究旨在报告血管内诊断和治疗慢性脑脊髓静脉功能不全相关的 30 天发病率和死亡率。
回顾性分析 2010 年 6 月至 2011 年 9 月期间 95 例连续患者（60 例女性和 35 例男性）的病历，这些患者平均年龄为 48 岁（年龄范围为 25-66 岁），因慢性脑脊髓静脉功能不全接受血管内诊断性评估和介入治疗。所有患者均符合 McDonald 标准诊断为多发性硬化症。通过数字减影血管造影和血管内超声对内颈静脉和奇静脉进行血管内评估。经皮腔内血管成形术（PTA）的适应证为血管造影显示直径狭窄大于 50%、数字减影血管造影存在反流、血管内超声显示横截面积狭窄大于 50%、或两种方法均发现异常厚瓣膜或隔膜。本研究的主要终点是 30 天死亡率，次要终点是主要并发症的发生。结果以平均值和百分比表示。
95 例患者共进行了 107 次手术。血管内评估显示 95 例患者中有 90 例（94.7%）存在需要介入治疗的静脉病变，95 例中有 5 例（5.3%）评估结果为阴性。共治疗了 193 个静脉病变；193 个病变中有 188 个（97.4%）经 PTA 治疗后技术上成功。在接受治疗的 95 例患者中有 3 例（3.2%）患者出现颈内静脉 PTA 后血栓形成。95 例患者中有 4 例（4.2%）出现无需输血的穿刺部位出血。未报告与手术相关的死亡病例。
目前的研究结果表明，血管内诊断和治疗慢性脑脊髓静脉功能不全是安全的，发病率低，无手术相关死亡率。
