Stuck Anna K, Reich Thomas, Engelberger Rolf P, Sebastian Tim, Kucher Nils
1 Department of Geriatrics, Inselspital, University Hospital, Bern, Switzerland.
2 University of Bern, Medical Faculty, Bern, Switzerland.
Vasa. 2018 Jun;47(4):319-325. doi: 10.1024/0301-1526/a000697. Epub 2018 Mar 7.
The aim of the study was to investigate venous patency and clinical outcomes for endovascular treatment of iliofemoral venous obstruction in patients with post-thrombotic syndrome (PTS) and non-thrombotic iliac vein lesion (NIVL) with dedicated self-expanding nitinol stents.
Data were collected from the prospective Swiss Venous Stent Registry, enrolling consecutive patients with a standardized follow-up procedure since January 2008. Patency was evaluated by duplex sonography and clinical outcome by various scores including the Villalta score at baseline, three, six, and 12 months, and then annually after endovascular therapy.
Overall, 93 patients (64 PTS, 29 NIVL) were analysed. Mean follow-up time was 20 ± 16 (range 3-70) months. A total of 11 (12 %) patients had a stent occlusion, all of which occurred in the PTS group, and 13 (14 %) patients had a symptomatic stent stenosis. Primary patency was 79 % (95 % CI 68-87 %) at 12 months and 72 % (95 % CI 59-82 %) at 24 months. In PTS patients, primary patency at 12 months was 75 % (95 % CI 61-84 %) vs. 89 % (95 % CI 63-97 %) in NIVL patients (p = 0.10). Secondary patency at 24 months was 94 % (95 % CI 84-98 %) in PTS and 100 % in NIVL, p = 0.19). Overall, 62 (67 %) patients were free from PTS at the latest follow-up with a Villalta score < 5 points. Predictive factors for the loss of primary patency were stents placed below the inguinal ligament (OR 2.59, 95 % CI, 0.99-6.84, p = 0.05).
In symptomatic patients with chronic iliofemoral vein obstruction, endovascular therapy with self-expanding nitinol stents was associated with favourable patency rates and clinical improvement in the majority of patients.
本研究旨在探讨使用专用自膨式镍钛合金支架对血栓后综合征（PTS）和非血栓性髂静脉病变（NIVL）患者进行髂股静脉阻塞血管腔内治疗的静脉通畅情况和临床结局。
数据收集自前瞻性瑞士静脉支架注册研究，自2008年1月起纳入连续患者并采用标准化随访程序。通过双功超声评估通畅情况，通过包括基线、3个月、6个月和12个月时的Villalta评分以及血管腔内治疗后每年的各种评分评估临床结局。
总体上，分析了93例患者（64例PTS，29例NIVL）。平均随访时间为20±16（范围3 - 70）个月。共有11例（12%）患者发生支架闭塞，均发生在PTS组，13例（14%）患者出现有症状的支架狭窄。12个月时的初始通畅率为79%（95%可信区间68 - 87%），24个月时为72%（95%可信区间59 - 82%）。在PTS患者中，12个月时的初始通畅率为75%（95%可信区间61 - 84%），而NIVL患者为89%（95%可信区间63 - 97%）（p = 0.10）。24个月时的次级通畅率在PTS患者中为94%（95%可信区间84 - 98%），在NIVL患者中为100%（p = 0.19）。总体而言，在最近一次随访时，62例（67%）患者的Villalta评分<5分，无PTS。初始通畅丧失的预测因素是支架放置在腹股沟韧带下方（比值比2.59，95%可信区间0.99 - 6.84，p = 0.05）。
对于有症状的慢性髂股静脉阻塞患者，使用自膨式镍钛合金支架进行血管腔内治疗在大多数患者中具有良好的通畅率和临床改善效果。
