Huang Chongqing, Yu Guanfeng, Huang Jingyong
Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Ann Vasc Surg. 2018 May;49:57-63. doi: 10.1016/j.avsg.2018.01.062. Epub 2018 Feb 9.
The efficacy of endovascular interventional treatment for iliac vein compression syndrome (IVCS) is not well studied. The purpose of our study was to investigate the clinical outcome of endovascular interventional treatment for IVCS.
Data of 68 patients with IVCS, who underwent interventional treatment in our hospital, were analyzed retrospectively. Among these patients, 46 had lower extremity varicose veins. Sixty-five patients underwent stent implantation, and 3 patients underwent simple balloon angioplasty. Fourteen patients had post-thrombotic syndrome (PTS) and 11 patients had acute deep venous thrombosis (DVT). Among these 14 patients with PTS, 12 underwent stent implantation and 2 underwent iliac venous simple balloon angioplasty. On the other hand, 9 of the 11 patients with DVT underwent catheter-directed thrombolysis (CDT) and then stent implantation. Of the remaining 2 patients, one underwent Angiojet Rheolytic thrombectomy (ART) before CDT and the other underwent CDT with simple balloon angioplasty. The stenosis rate of iliac vein and the circumference differences between the affected limb and healthy one were measured before and after operation. These patients were followed up with duplex ultrasound postoperatively.
A total of 75 stents were placed in 65 patients. The diameter and the length of stent were 6 to 14 mm (mean 12.5 ± 2.0 mm) and 40 to 260 mm (mean 82.5 ± 36.9 mm), respectively. CDT with/without ART was performed, using urokinase and/or alteplase, after inferior vena cava filtration in all of 11 patients with DVT, without the recurrence of pulmonary embolism. The difference in iliac venous stenosis was statistically significant ([91.2% ± 8.4%] [70.0% ∼ 100.0%] vs. 3.9% ± 13.0% [0 ∼ 70.0%], P < 0.01). The patency rates at 1-, 3-, 6- months, 1 year, and 2 years were 98.5%, 95.6%, 94.1%, 92.4%, and 90.7%, respectively. Four patients (5.9%) suffered from minor bleeding at puncture point and were successfully treated with compression. However, 1 (1.5%) patient underwent stent implantation of right iliac vein that became complicated due to migration of stent to the right ventricle which was successfully arrested by Amplatz Goose Neck Snare Kit. The incidence of PTS was 10.3% (7/68) during the follow-up at 1 to 24 (mean 18.2 ± 7.7) months.
Interventional therapy for patients of IVCS is safe and effective. Satisfactory outcomes were obtained for stent placement for IVCS.
血管内介入治疗髂静脉压迫综合征（IVCS）的疗效尚未得到充分研究。本研究的目的是探讨血管内介入治疗IVCS的临床效果。
回顾性分析我院68例接受介入治疗的IVCS患者的数据。其中46例患者合并下肢静脉曲张。65例患者接受了支架植入，3例患者接受了单纯球囊血管成形术。14例患者有血栓形成后综合征（PTS），11例患者有急性下肢深静脉血栓形成（DVT）。在这14例PTS患者中，12例接受了支架植入，2例接受了髂静脉单纯球囊血管成形术。另一方面，11例DVT患者中有9例接受了导管直接溶栓（CDT），然后进行了支架植入。其余2例患者中，1例在CDT前接受了Angiojet机械血栓清除术（ART），另1例接受了CDT联合单纯球囊血管成形术。测量手术前后髂静脉狭窄率以及患侧与健侧肢体周径差。术后采用双功超声对这些患者进行随访。
65例患者共植入75枚支架。支架直径和长度分别为6至14毫米（平均12.5±2.0毫米）和40至260毫米（平均82.5±36.9毫米）。11例DVT患者均在下腔静脉滤器置入后，使用尿激酶和/或阿替普酶进行了有或无ART的CDT，无肺栓塞复发。髂静脉狭窄差异有统计学意义（[91.2%±8.4%] [70.0%～100.0%] 对比 3.9%±13.0% [0～70.0%]，P<0.01）。1个月、3个月、6个月、1年和2年的通畅率分别为98.5%、95.6%、94.1%、92.4%和90.7%。4例患者（5.9%）穿刺点出现轻微出血，经压迫成功治疗。然而，1例（1.5%）患者右髂静脉支架植入后出现支架移位至右心室的并发症，通过Amplatz鹅颈圈套器成功处理。随访1至24个月（平均18.2±7.7个月）期间，PTS发生率为10.3%（7/68）。
IVCS患者的介入治疗安全有效。IVCS支架置入取得了满意的效果。
