Kazibudzki Marek, Latacz Pawel, Ludyga Tomasz, Simka Marian
Euromedic Medical Center, Department of Vascular Surgery, Katowice, Poland -
J Cardiovasc Surg (Torino). 2016 Aug;57(4):514-8. Epub 2013 Oct 24.
In this technical note we present the results of endovascular treatment for chronic cerebrospinal venous insufficiency with the use of cutting balloons, with focus on feasibility and safety of these endovascular devices.
We used cutting balloons during 70 procedures in 65 multiple sclerosis patients presenting with strictures of the internal jugular veins, primarily at the level of jugular valves. These devices were used only in selected cases, following unsuccessful standard balloon angioplasty, and on condition that commercially available devices could be applied (currently they are maximally 8 mm in diameter).
In all cases the perioperative course was uneventful, with no serious adverse events. Immediate technical success rate was 94.3%. In four cases (5.7%) cutting-balloon angioplasty alone was unsuccessful and stents were implanted. Primary, assisted primary and secondary patency rates after 6 months were: 94%, 98.5%, and 98.5%, respectively. Follow-up has revealed that out of the remaining 66 angioplasties four procedures failed (failure rate: 6.1%): in two patients stents were implanted, in one patient successful redo cutting-balloon angioplasty was performed, while in another case the treated segment of jugular vein totally occluded and was not feasible to reopen endovascularly.
Cutting balloons can be safely used for the management of stenosed internal jugular veins. These devices can replace stents in the majority of cases, especially if standard balloon angioplasty is insufficient to restore proper outflow. However, the use of cutting balloons in this particular venous territory is limited by the fact that currently only small diameter devices are available.
在本技术说明中，我们展示了使用切割球囊对慢性脑脊髓静脉功能不全进行血管内治疗的结果，重点关注这些血管内装置的可行性和安全性。
我们在65例患有颈内静脉狭窄（主要在颈静脉瓣水平）的多发性硬化症患者的70次手术中使用了切割球囊。这些装置仅在标准球囊血管成形术失败且可应用市售装置（目前其最大直径为8毫米）的特定情况下使用。
所有病例围手术期过程均顺利，无严重不良事件。即刻技术成功率为94.3%。4例（5.7%）仅行切割球囊血管成形术未成功，随后植入了支架。6个月后的原发性、辅助原发性和继发性通畅率分别为94%、98.5%和98.5%。随访发现，在其余66次血管成形术中，有4次手术失败（失败率：6.1%）：2例患者植入了支架，1例患者成功再次进行了切割球囊血管成形术，而另1例患者颈静脉治疗段完全闭塞，无法通过血管内重新开通。
切割球囊可安全用于治疗狭窄的颈内静脉。在大多数情况下，这些装置可替代支架，尤其是在标准球囊血管成形术不足以恢复正常血流时。然而，在这个特定的静脉区域使用切割球囊受到目前仅有小直径装置可用这一事实的限制。
