Sang Hong-Fei, Li Jia-Hong, Du Xiao-Long, Li Weng-Dong, Lei Feng-Rui, Yu Xiao-Bin, Zhu Li-Wei, Li Cheng-Long, Li Xiao-Qiang
1 Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
2 Department of Vascular Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China.
Phlebology. 2019 Feb;34(1):40-51. doi: 10.1177/0268355518764989. Epub 2018 Apr 10.
To report *The first two authors contributed equally to this work. our clinical experience on diagnostic criteria and endovascular management in patients with iliac venous compression syndrome.
Between July 2013 and May 2015, 85 consecutive patients with suspected iliac venous compression syndrome were evaluated by transfemoral venography and intravascular ultrasonography. Venographic evidence of iliac venous occlusion, stenosis, or pelvic collateral vessels, and the degree of stenosis as examined with intravascular ultrasonography were recorded. The endovascular procedure, complications, clinical outcome, and the Venous Clinical Severity Score were evaluated before and after the intervention.
Of the 85 limbs, 66 cases of iliac venous compression syndrome were confirmed and 19 cases were excluded. In all of the 66 patients, we successfully performed endovascular intervention (22 balloon dilations, 44 balloon dilations + stenting). Two patients with stent implantation developed acute lower extremity deep vein thrombosis, resulted in successful lysis of the thrombus with catheter-directed thrombolysis.
The presence of intraluminal spurs and pelvic collateral vessels represents not only pathological and anatomical changes by long-term mechanical compression, but also indicators of the severity of iliac venous compression syndrome. The degree of stenosis cannot accurately represent the severity and treatment of iliac venous compression syndrome, especially in the right iliac vein. Endovascular intervention is a safe and effective treatment that reduces lower extremity symptoms. Full and intentional dilation of the intraluminal spurs is an important technical aspect, which is often ignored.
报告我们在髂静脉受压综合征患者诊断标准及血管内治疗方面的临床经验。前两位作者对本工作贡献相同。
2013年7月至2015年5月期间，对85例连续疑似髂静脉受压综合征的患者进行了经股静脉造影和血管内超声检查。记录髂静脉闭塞、狭窄或盆腔侧支血管的静脉造影证据，以及血管内超声检查的狭窄程度。评估干预前后的血管内操作、并发症、临床结果及静脉临床严重程度评分。
85条肢体中，确诊髂静脉受压综合征66例，排除19例。66例患者均成功进行了血管内干预（22例球囊扩张，44例球囊扩张+支架置入）。2例支架置入患者发生急性下肢深静脉血栓形成，经导管直接溶栓成功溶解血栓。
腔内嵴和盆腔侧支血管的存在不仅代表长期机械压迫引起的病理和解剖变化，也是髂静脉受压综合征严重程度的指标。狭窄程度不能准确反映髂静脉受压综合征的严重程度和治疗情况，尤其是在右髂静脉。血管内干预是一种安全有效的治疗方法，可减轻下肢症状。充分且有意地扩张腔内嵴是一个重要的技术方面，常被忽视。
