Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
Br J Surg. 2017 May;104(6):718-725. doi: 10.1002/bjs.10461. Epub 2017 Feb 21.
Good results have been reported for angioplasty and stenting of post-thrombotic lesions of the iliac and proximal femoral veins. If lesions at the origin of the superficial femoral and profunda veins are stented, the intraluminal synechiae can be pushed against the orifices of inflow vessels, potentially decreasing stent inflow. Surgical disobliteration of the common femoral vein (endophlebectomy) has been suggested to mitigate this problem. Because of a temporary increase in thrombogenicity, this procedure may be accompanied by arteriovenous fistula creation.
Data on consecutive patients treated by hybrid venous reconstruction, between December 2010 and May 2015, were analysed. Standard recording consisted of clinical scoring systems (including Villalta scale) and imaging. Patency was assessed with duplex ultrasonography.
Seventy-six legs (70 patients) were included. Median follow-up was 379 (range 73-1508) days. Primary, assisted primary and secondary patency rates at 12 months were 51, 70 and 83 per cent respectively. Sixty per cent of loss of primary patency (24 of 40 legs) was related to common femoral vein stenosis, and the rest to rethrombosis. Other complications included wound infection (29 per cent) and lymphatic leak (39 per cent). The Villalta score had decreased by a median of 7 points at 1-year follow-up.
The combination of venous stenting, endophlebectomy and arteriovenous fistula creation for patients with extensive post-thrombotic vein damage and severe post-thrombotic syndrome is feasible.
经皮腔内血管成形术和支架置入术治疗髂静脉和股总静脉血栓后病变已取得良好效果。如果对股浅静脉和股深静脉起始处的病变进行支架置入，腔内粘连可能会被推向流入血管的开口，从而可能减少支架的流入。有人建议对股总静脉进行手术再通（静脉内膜切除术）以减轻这一问题。由于血栓形成性暂时增加，该手术可能伴有动静脉瘘的形成。
分析了 2010 年 12 月至 2015 年 5 月间采用混合静脉重建治疗的连续患者的数据。标准记录包括临床评分系统（包括 Villalta 量表）和影像学检查。采用双功能超声检查评估通畅性。
共纳入 76 条肢体（70 例患者）。中位随访时间为 379 天（范围 73-1508 天）。12 个月时的原发性、辅助原发性和继发性通畅率分别为 51%、70%和 83%。24 条肢体（60%）原发性通畅率丧失与股总静脉狭窄有关，其余与再血栓形成有关。其他并发症包括伤口感染（29%）和淋巴漏（39%）。Villalta 评分在 1 年随访时平均下降了 7 分。
对于广泛血栓后静脉损伤和严重血栓后综合征的患者，静脉支架置入、静脉内膜切除术和动静脉瘘形成相结合是可行的。
