Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
Eur J Vasc Endovasc Surg. 2015 Jul;50(1):101-7. doi: 10.1016/j.ejvs.2015.03.029. Epub 2015 Apr 25.
The study aimed to evaluate the clinical results of stent placement in post-thrombotic patients with iliofemoral obstruction compared with results in those treated with elastic compression stockings (ECS).
A retrospective analysis of post-thrombotic patients with iliofemoral obstruction was conducted in a single institution from January 2007 to December 2012. Duplex ultrasound and selective phlebography were performed in patients with chronic venous disease and previous deep venous thrombosis (DVT). Post-thrombotic syndrome (PTS) with iliofemoral vein obstruction (Villalta score ≥10) was diagnosed in 216 patients. Among these, 122 patients were treated by stent placement, and the remaining 94 patients were treated conservatively with 30-40 mmHg ECS therapy. Technical success, stent patency rates, and complications were recorded after the interventions. Results including Villalta score, pain, edema, ulcer, and popliteal vein reflux were assessed in both groups.
Percutaneous iliofemoral venous stenting was successful in 116 of 122 patients (95.1%) without major complications. Follow up periods ranged from 3 to 58 months (median 21 months). Cumulative primary, assisted primary, and secondary stent patency rates at 3 years were 68.9%, 79.0%, and 91.6%, respectively. Among patients with severe PTS, the Villalta score decreased significantly with endotreatment, compared to the score of those treated by ECS therapy (16.12 ± 4.91 vs. 10.98 ± 5.89, p < .01). However, there was no significant score improvement between the two therapies in patients with moderate PTS (6.59 ± 2.37 vs. 5.75 ± 3.03, p = .22). There was a significantly higher 24 month recurrence free ulcer healing rate in the endotreatment groups (86.6% vs. 70.6%, p < .01). Both edema and pain improved significantly in the two groups. The popliteal vein reflux rate showed no significant change after endotreatment.
Endovascular treatment is a safe, effective, and feasible method to correct the iliofemoral obstruction of PTS. Only post-thrombotic patients with severe PTS as assessed by the Villalta score appear to benefit from the endovascular treatment.
本研究旨在评估支架置入术治疗髂股静脉阻塞性血栓后综合征（PTS）患者的临床效果，并与弹性压迫治疗（ECS）的结果进行比较。
回顾性分析 2007 年 1 月至 2012 年 12 月在我院接受治疗的髂股静脉阻塞性 PTS 患者。对慢性静脉疾病和深静脉血栓形成（DVT）病史的患者进行双功能超声和选择性静脉造影。216 例 PTS 患者伴有髂股静脉阻塞（Villalta 评分≥10），其中 122 例行支架置入术，94 例行 ECS 治疗。记录介入治疗后的技术成功率、支架通畅率和并发症。评估两组患者的 Villalta 评分、疼痛、肿胀、溃疡和腘静脉反流等情况。
122 例患者中有 116 例（95.1%）支架置入术成功，无严重并发症。随访时间 3~58 个月（中位数 21 个月）。3 年时的累积一期、辅助一期和二期通畅率分别为 68.9%、79.0%和 91.6%。与 ECS 治疗组相比，重度 PTS 患者的Villalta 评分在治疗后显著降低（16.12±4.91 比 10.98±5.89，p<0.01）。但中度 PTS 患者两组间治疗后评分无显著改善（6.59±2.37 比 5.75±3.03，p=0.22）。治疗组 24 个月溃疡愈合的无复发率显著较高（86.6%比 70.6%，p<0.01）。两组患者的肿胀和疼痛均明显改善。治疗后腘静脉反流率无明显变化。
血管内治疗是纠正 PTS 髂股静脉阻塞的一种安全、有效且可行的方法。只有根据 Villalta 评分评估为重度 PTS 的患者，血管内治疗才会获益。
