Ruihua Wang, Xin Wang, Guang Liu, Kaichuang Ye, Jinbao Qin, Minyi Yin, Weimin Li, Xiaobing Liu, Xintian Huang, Min Lu, Xinwu Lu
Department of Vascular Surgery and Vascular Center of Shanghai Jiao Tong University, School of Medicine, Shanghai 9th People's Hospital Affiliated to Shanghai Jiao Tong University,639 Zhi Zao Ju Rd., Shanghai200011, China.
Department of Vascular Surgery and Vascular Center of Shanghai Jiao Tong University, School of Medicine, Shanghai 9th People's Hospital Affiliated to Shanghai Jiao Tong University,639 Zhi Zao Ju Rd., Shanghai200011, China.
J Vasc Interv Radiol. 2017 Mar;28(3):373-379. doi: 10.1016/j.jvir.2016.11.003. Epub 2017 Jan 16.
To evaluate the technical aspects and early clinical results of combined stent placement for the management of postthrombotic syndrome (PTS) in chronic total occlusions (CTOs) of the iliofemoral veins.
A total of 81 consecutive patients (mean age, 57 y; 37 men; 81 limbs; 65 left limbs) with postthrombotic CTO of the iliofemoral veins treated with combined stent placement in a single institution from January 2013 to December 2014 were retrospectively analyzed. Wallstents were used for femoral inflow and E-Luminexx stents for iliac outflow. Technical aspects, quality of life (QOL), stent patency, and Villalta scores were recorded at follow-up. Primary, primary assisted, and secondary patency rates were estimated with Kaplan-Meier methods with the log-rank test.
Percutaneous recanalization was successful in 77 of 81 limbs (95.1%). Stents were deployed in all iliofemoral occlusions, with two stents in 63 lesions (77.8%) lesions and three stents in 18 lesions (22.2%). Venous perforation occurred in 32 patients (37.4%) and was resolved in all cases after stent placement. Back pain occurred during balloon angioplasty (93.8%) and persisted after stent placement in 56.8% of patients. However, the symptoms were self-limiting without further therapy. QOL and Villalta scores were significantly improved during a median follow-up of 19 months (range, 1-38 mo; P < .01). The 2-year primary, primary assisted, and secondary cumulative stent patency rates were 81.5%, 91.4%, and 93.8%, respectively.
Combined stent placement is an effective, safe, and feasible method of management of PTS in iliofemoral CTO until commercial venous stents designed for PTS become available.
评估联合支架置入术治疗髂股静脉慢性完全闭塞（CTO）后血栓形成综合征（PTS）的技术要点及早期临床疗效。
回顾性分析2013年1月至2014年12月在单一机构接受联合支架置入术治疗的81例连续的髂股静脉血栓形成后CTO患者（平均年龄57岁；男性37例；81条肢体；65条左下肢）。使用Wallstents支架用于股静脉流入道，E-Luminexx支架用于髂静脉流出道。随访时记录技术要点、生活质量（QOL）、支架通畅情况及Villalta评分。采用Kaplan-Meier法和对数秩检验估计原发性、原发性辅助性和继发性通畅率。
81条肢体中有77条（95.1%）经皮再通成功。所有髂股闭塞病变均置入支架，63处病变（77.8%）置入2枚支架，18处病变（22.2%）置入3枚支架。32例患者（37.4%）发生静脉穿孔，支架置入后所有病例均得到解决。球囊血管成形术期间出现背痛的患者占93.8%，56.8%的患者在支架置入后仍持续存在。然而，这些症状无需进一步治疗即可自行缓解。在中位随访19个月（范围1 - 38个月；P <.01）期间，QOL和Villalta评分显著改善。2年原发性、原发性辅助性和继发性累积支架通畅率分别为81.5%、91.4%和93.8%。
在专门用于PTS的商用静脉支架问世之前，联合支架置入术是治疗髂股CTO中PTS的一种有效、安全且可行的方法。
