Jiang Kun, Li Xiao-Qiang, Sang Hong-Fei, Qian Ai-Min, Rong Jian-Jie, Li Cheng-Long
The Second Affiliated Hospital of Soochow University, Suzhou City, China.
Phlebology. 2017 Apr;32(3):200-206. doi: 10.1177/0268355516640370. Epub 2016 Jul 9.
Purposes of the study To evaluate the benefit of stenting the iliac vein in patients with residual iliac vein stenosis treated with catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis. Procedures In this randomized prospective study, patients with a first-time acute lower extremity deep venous thrombosis that had persisted <14 days were treated with catheter-directed thrombolysis. After catheter-directed thrombolysis, patients with >50% residual iliac vein stenosis were randomly divided into two groups: catheter-directed thrombolysis + Stent Group and catheter-directed thrombolysis Alone Group. Patients received urokinase thrombolysis and low-molecular-weight heparin/oral warfarin during the hospitalization period and were administrated oral warfarin after discharge. Cumulative deep vein patency, the Clinical Etiology Anatomic Pathophysiologic classification system, the Venous Clinical Severity Score and the Chronic Venous Insufficiency Questionnaire score were evaluated. Findings The cumulative deep vein patency rate was 74.07% in the catheter-directed thrombolysis + Stent Group and 46.59% in the catheter-directed thrombolysis Alone Group. The mean postoperative Clinical Etiology Anatomic Pathophysiologic classification and Venous Clinical Severity Score was significantly lower in the catheter-directed thrombolysis + Stent Group than in the catheter-directed thrombolysis Alone Group. The mean postoperative Chronic Venous Insufficiency Questionnaire score was significantly higher in the catheter-directed thrombolysis + Stent Group than the catheter-directed thrombolysis Alone Group. Conclusions Placement of an iliac vein stent in patients with residual iliac vein stenosis after catheter-directed thrombolysis for acute lower extremity deep venous thrombosis increases iliac vein patency and improves clinical symptoms and health-related quality of life at mid-term follow-up compared to patients treated with catheter-directed thrombolysis alone.
评估在接受导管直接溶栓治疗急性髂股深静脉血栓形成后残留髂静脉狭窄的患者中置入髂静脉支架的益处。
在这项随机前瞻性研究中，首次发生且持续时间<14天的急性下肢深静脉血栓形成患者接受导管直接溶栓治疗。导管直接溶栓后，残留髂静脉狭窄>50%的患者被随机分为两组：导管直接溶栓+支架组和单纯导管直接溶栓组。患者在住院期间接受尿激酶溶栓和低分子量肝素/口服华法林治疗，出院后给予口服华法林。评估累积深静脉通畅情况、临床病因解剖病理生理分类系统、静脉临床严重程度评分和慢性静脉功能不全问卷评分。
导管直接溶栓+支架组的累积深静脉通畅率为74.07%，单纯导管直接溶栓组为46.59%。导管直接溶栓+支架组术后平均临床病因解剖病理生理分类和静脉临床严重程度评分显著低于单纯导管直接溶栓组。导管直接溶栓+支架组术后慢性静脉功能不全问卷平均评分显著高于单纯导管直接溶栓组。
与单纯接受导管直接溶栓治疗的患者相比，急性下肢深静脉血栓形成患者在导管直接溶栓后残留髂静脉狭窄时置入髂静脉支架，在中期随访时可提高髂静脉通畅率，改善临床症状和与健康相关的生活质量。
