Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala.
Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala.
J Vasc Surg Venous Lymphat Disord. 2017 Jul;5(4):500-505. doi: 10.1016/j.jvsv.2017.01.018. Epub 2017 Apr 5.
The purpose of this study was to evaluate outcomes of iliac vein stents placed for iliocaval venous obstruction (ICVO) and to determine if routine follow-up surveillance is warranted on the basis of timing of stent failure.
All patients who underwent iliac vein stenting from 2003 to 2015 were identified from a prospectively maintained registry. Demographics of the patients, venous risk factors, prior venous interventions, indications, imaging, anatomic location of the ICVO, operative findings, procedural success, complications, and clinical follow-up were recorded. Clinical and ultrasound surveillance was performed at first postoperative follow-up and at routine subsequent intervals. Continuous data were analyzed with Student t-tests or Mann-Whitney U test, and frequency data were analyzed with χ analysis or Fisher exact test. Primary patency was analyzed using Kaplan-Meier survival analysis.
Seventy-four limbs in 70 patients who underwent iliac vein stenting for ICVO were identified; 36 limbs (48.6%) were stented for nonthrombotic venous compression (stent-VC), and 38 limbs (51.4%) were stented for venous thrombosis (stent-VT). Twenty-seven limbs (71.1%) of the stent-VT group were treated for acute venous thrombosis requiring lysis followed by stenting for underlying venous lesions. The median number of follow-up visits for the stent-VC and stent-VT groups was two (interquartile range [IQR], 1-4) and two (IQR, 1-3), whereas the mean length of follow-up was 19.6 ± 29.5 months and 19.8 ± 26.5 months (P = .972), respectively. During the first 6 months, one limb (2.8% [n = 36]) in the stent-VC group occluded, whereas 13.2% (5/38) of the limbs in the stent-VT group occluded. In the stent-VT group, 57% of limbs (4 of 7) with acute venous thrombosis requiring thrombolytic therapy had limb occlusion at >6 months (median, 18.1 months; IQR, 16.6-30.1). Overall patency rates for the stent-VC and stent-VT groups were 97.2% (1/36) and 73.7% (10/38) at 36 months (standard error, ≤10%; P = .001), respectively.
Iliac vein stents placed for nonthrombotic iliac vein compression had statistically higher patency than those placed for venous thrombosis, with few stent failures, all occurring within 6 months. Iliac vein stents placed for venous thrombosis continued with stent failure after 6 months and may benefit from extended surveillance.
本研究旨在评估因髂静脉阻塞（ICVO）而放置的髂静脉支架的治疗效果，并确定根据支架失效的时间是否需要进行常规随访监测。
从一个前瞻性维护的登记处确定了 2003 年至 2015 年间接受髂静脉支架置入术的所有患者。记录患者的人口统计学资料、静脉危险因素、既往静脉介入治疗、适应证、影像学、ICVO 的解剖位置、手术发现、手术成功率、并发症和临床随访情况。术后首次随访和随后的常规随访进行临床和超声监测。连续数据采用学生 t 检验或曼-惠特尼 U 检验进行分析，频率数据采用卡方检验或 Fisher 确切概率法进行分析。采用 Kaplan-Meier 生存分析评估主要通畅率。
共确定了 70 例因 ICVO 接受髂静脉支架置入术的 74 条肢体；36 条肢体（48.6%）因非血栓性静脉压迫（支架-VC）而置入支架，38 条肢体（51.4%）因静脉血栓形成（支架-VT）而置入支架。支架-VT 组中有 27 条肢体（71.1%）为急性静脉血栓形成，需要溶栓治疗，随后对潜在静脉病变进行支架置入。支架-VC 组和支架-VT 组的中位随访次数为 2 次（四分位距[IQR]，1-4 次）和 2 次（IQR，1-3 次），平均随访时间分别为 19.6±29.5 个月和 19.8±26.5 个月（P=0.972）。在最初的 6 个月内，支架-VC 组中有 1 条肢体（2.8%[n=36]）闭塞，而支架-VT 组中有 13.2%（5/38）的肢体闭塞。在支架-VT 组中，需要溶栓治疗的 7 条急性静脉血栓形成肢体中有 5 条（57%）在>6 个月时出现肢体闭塞（中位时间，18.1 个月；IQR，16.6-30.1）。支架-VC 组和支架-VT 组的总体通畅率分别为 97.2%（1/36）和 73.7%（10/38），36 个月时的标准误差均≤10%（P=0.001）。
因非血栓性髂静脉压迫而放置的髂静脉支架通畅率明显高于因静脉血栓形成而放置的支架，支架失败率较低，所有支架失败均发生在 6 个月内。因静脉血栓形成而放置的支架在 6 个月后继续发生支架失败，可能需要延长监测。
