Aurshina Afsha, Ganelin Arkady, Hingorani Anil, Blumberg Sheila, Ostrozhynskyy Yuriy, Kheyson Borislav, Ascher Enrico
Department of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY, USA.
Vascular. 2018 Apr;26(2):126-131. doi: 10.1177/1708538117715343. Epub 2017 Sep 18.
Objective The purpose of the study is to evaluate normal anatomical areas of infrarenal inferior vena cava, common iliac, external iliac and common femoral veins by intravascular ultrasound with the goal of assisting the development of venous-specific stents in the treatment of iliac vein stenosis. Method From February 2012 to December 2013, 656 office-based venograms were performed in our facility. Among them, 576 were stented and 80 were not. The measurements of veins were done intraoperatively using an intravascular ultrasound catheter to record areas of the inferior vena cava, proximal, middle and distal segments of common iliac vein, external iliac vein and common femoral vein. The data were compared between non-diseased segments of patients who were stented and those not stented. The stented diseased segments were excluded. Results The mean patient age was 67.33 years (range 22-96, SD ±13.99). Our data included 218 males, 438 females and 324 right lower extremities and 332 left lower extremities. The presenting symptoms of these patients based on CEAP were C1(0), C2 (185), C3(233), C4(107), C5(89) and C6(42). No correlation was found between area of veins and age, gender, laterality and CEAP score (P > .13). Comparison of the areas of non-diseased iliac vein segments between patients not stented and patients who underwent stenting showed a significant difference, with larger areas in non-stented patients in the distal common iliac vein (P = .039) and inferior vena cava (P = .012). Younger age (P = .03) and male gender (P < .0001) were associated with increased area of iliac vein segments. Conclusion Utilizing the intravascular ultrasound-guided technique, we were able to define normal anatomical areas of non-diseased inferior vena cava, iliac and femoral veins, which could be employed to guide the development of appropriate-sized stents and other tools needed for the treatment of venous insufficiency. There is specific variability in areas of normal vein segments with age and gender with/without stents.
目的 本研究旨在通过血管内超声评估肾下下腔静脉、髂总静脉、髂外静脉和股总静脉的正常解剖区域，以辅助开发用于治疗髂静脉狭窄的静脉专用支架。方法 2012年2月至2013年12月，我们机构进行了656例门诊静脉造影。其中，576例进行了支架置入，80例未置入。术中使用血管内超声导管测量静脉，记录下腔静脉、髂总静脉近端、中段和远端、髂外静脉和股总静脉的面积。对置入支架患者和未置入支架患者的无病变节段的数据进行比较。排除置入支架的病变节段。结果 患者平均年龄为67.33岁（范围22 - 96岁，标准差±13.99）。我们的数据包括218名男性、438名女性，右下肢324例，左下肢332例。根据CEAP分类，这些患者的主要症状为C1(0)、C2(185)、C3(233)、C4(107)、C5(89)和C6(42)。未发现静脉面积与年龄、性别、侧别和CEAP评分之间存在相关性（P > 0.13）。未置入支架患者和接受支架置入患者的无病变髂静脉节段面积比较显示出显著差异，未置入支架患者在髂总静脉远端（P = 0.039）和下腔静脉（P = 0.012）的面积更大。年龄较小（P = 0.03）和男性（P < 0.0001）与髂静脉节段面积增加有关。结论 利用血管内超声引导技术，我们能够确定无病变的下腔静脉、髂静脉和股静脉的正常解剖区域，这可用于指导开发治疗静脉功能不全所需的合适尺寸的支架和其他工具。正常静脉节段的面积在有/无支架的情况下随年龄和性别存在特定差异。
