Pokrovskiĭ A V, Ignat'ev I M, Volodiukhin M Iu, Gradusov E G
Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health, Moscow, Russia; Russian Medical Academy of Postgraduate Education, Moscow, Russia.
Interregional Clinical Diagnostic Centre, Kazan, Russia; Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia.
Angiol Sosud Khir. 2016;22(3):131-8.
The present study was aimed at assessing initial results of hybrid operations in obstructive lesions of the iliac-femoral veins in patients with post-thrombotic disease (PTD). Hybrid operations [open endovenectomy from the common femoral vein (CFV) with creation of an arteriovenous fistula + stenting of iliac veins] were performed carried out in a total of eleven patients with PTD. Of these, there were 7 men and 4 women aged from 34 to 52 years (mean age - 42.8±7 years). All patients had severe-degree chronic venous insufficiency (CVI). The distribution of patients according to the CEAP classification was as follows: C4a - 2 patients, C4b - 4 patients, C5 - 4 subjects, C6 - 1 patient. The time having elapsed since a newly onset episode of acute iliac-femoral venous thrombosis varied from 2 to 12 years (averagely - 7.1±3.3 years). The degree of manifestation of PTD was determined by means of the Villalta-Pradoni scale before and 6 months after the operation. Instrumental methods of study included ultrasound duplex scanning (USDS), magnetic resonance and/or multispiral computed venography, and contrast-enhanced X-ray venography. The technical success of the procedure amounted to 91%. In one patient with occlusion of the common and external iliac veins we failed to perform recanalization and stenting. A further one patient developed in-stent and CFV thrombosis on the second postoperative day. An attempt of catheter thrombolysis turned out unsuccessful. There were no wound complications in the postoperative period. Neither was pulmonary artery thromboembolism registered. The dynamic control was carried out by means of USDS before discharge from hospital and at 1, 3 and 6 months after the intervention. The outcomes of hybrid operations after 6 months were followed up in five patients. Secondary patency rate of the stented iliac veins amounted to 100%. No relapses of trophic ulcers were observed. According to the Villalta-Prandoni scale the value of the median of the composite index decreased from 15 to 7 (p=0.012). The first experience with hybrid operations for obstructive lesions of veins of the iliac-femoral segment demonstrated their high efficacy and safety. Efficiency of the operation was confirmed by significant clinical improvement and good results of patency of the restored-repaired segments of veins.
本研究旨在评估杂交手术治疗血栓形成后疾病（PTD）患者髂股静脉阻塞性病变的初步结果。对总共11例PTD患者实施了杂交手术[从股总静脉（CFV）进行开放式静脉内膜切除术并建立动静脉瘘+髂静脉支架置入术]。其中，男性7例，女性4例，年龄34至52岁（平均年龄-42.8±7岁）。所有患者均患有重度慢性静脉功能不全（CVI）。根据CEAP分类，患者分布如下：C4a - 2例患者，C4b - 4例患者，C5 - 4例患者，C6 - 1例患者。自急性髂股静脉血栓形成新发病例以来的时间为2至12年（平均-7.1±3.3年）。通过Villalta-Pradoni量表在手术前和手术后6个月确定PTD的表现程度。研究的器械方法包括超声双重扫描（USDS）、磁共振和/或多层螺旋计算机静脉造影以及增强X线静脉造影。该手术的技术成功率为91%。在1例髂总静脉和髂外静脉闭塞的患者中，我们未能进行再通和支架置入。另有1例患者在术后第二天发生支架内和CFV血栓形成。导管溶栓尝试未成功。术后期间无伤口并发症。也未记录到肺动脉血栓栓塞。在出院前以及干预后1、3和6个月通过USDS进行动态对照。对5例患者随访了6个月后的杂交手术结果。支架置入的髂静脉二次通畅率为100%。未观察到营养性溃疡复发。根据Villalta-Prandoni量表，综合指数中位数的值从15降至7（p = 0.012）。髂股段静脉阻塞性病变杂交手术的首次经验表明其具有高疗效和安全性。手术的有效性通过显著的临床改善以及修复后静脉段通畅的良好结果得到证实。
