Guo Xiangjiang, Shi Yaxue, Xie Hui, Zhang Lan, Xue Guanhua, Gu Leyi, Hao Changning, Yang Shuofei, Kan Kejia
Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Vascular Surgery, LONGHUA Hospital, Shanghai University of Traditional Chinese Medicine, No.725 Wanping South Road, Shanghai, 200032, China.
Eur J Med Res. 2017 Jan 23;22(1):3. doi: 10.1186/s40001-017-0243-3.
Although left innominate vein (LIV) stenosis has been demonstrated to be attributed to compression by adjacent anatomical structures, most of the studies are focusing on hemodialysis patients with clinical symptoms compatible with LIV stenosis. The goal of this study was to retrospectively investigate the incidence of LIV stenosis and its influencing factors in an asymptomatic, non-hemodialysis population, which has rarely been performed.
From Jan 2013 to Dec 2014, 212 consecutive cases undergoing a chest multi-detector computed tomography (MDCT) angiography were enrolled. LIV stenosis was defined as loss of the area of the LIV (that is, 1 - compression degree) >25%. Multivariate logistic regression analysis was performed to explore the independent risk factors associated with LIV stenosis.
LIV stenosis occurred in 35.4% of cases (75/212), with the median loss of the area of the LIV of 36.2% (interquartile range 30.2-49.8%). There were significant differences in age (62.5 ± 11.7 vs. 58.6 ± 14.3 years; P = 0.041), BMI (23.9 ± 2.9 vs. 23.0 ± 3.3, P = 0.036), the frequency of crossing site of LIV over the origin of the aortic arch (54.7 vs. 24.8%, P < 0.001), and the space between aortic arch and sternum [mean ± SD, 11.6 ± 4.2 mm vs. median, 14.1 (interquartile range 11.9-16.3) mm, P < 0.001] between patients with and without LIV stenosis, but only the latter two were confirmed as independent factors by the multivariate logistic regression analysis [crossing site of LIV over the aortic arch, OR (95% CI) = 2.632 (1.401, 4.944), P = 0.003; space between the aortic arch and sternum, OR (95% CI) = 0.841 (0.770, 0.919), P < 0.001].
The patients with an older age, high BMI, LIV crossing over the origin of the aortic arch, or smaller space between aortic arch and sternum may have high risks for LIV stenosis. They should be paid more attention to exclude LIV stenosis preoperatively using MDCT angiography to prevent venous access dysfunction and symptomatic development by fistula creation when hemodialysis is required.
尽管已证实左无名静脉（LIV）狭窄是由相邻解剖结构压迫所致，但大多数研究集中于有与LIV狭窄相符临床症状的血液透析患者。本研究的目的是回顾性调查无症状、非血液透析人群中LIV狭窄的发生率及其影响因素，此类研究鲜有开展。
纳入2013年1月至2014年12月期间连续接受胸部多排螺旋计算机断层扫描（MDCT）血管造影的212例患者。LIV狭窄定义为LIV面积减少（即1 - 压迫程度）>25%。进行多因素逻辑回归分析以探讨与LIV狭窄相关的独立危险因素。
75例（35.4%）患者发生LIV狭窄，LIV面积减少的中位数为36.2%（四分位间距30.2 - 49.8%）。有LIV狭窄和无LIV狭窄患者在年龄（62.5±11.7岁 vs. 58.6±14.3岁；P = 0.041）、体重指数（23.9±2.9 vs. 23.0±3.
