Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Obstetrics & Gynaecology, Haga Teaching Hospital, The Hague, The Netherlands.
Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Eur J Vasc Endovasc Surg. 2018 Aug;56(2):247-254. doi: 10.1016/j.ejvs.2018.04.013. Epub 2018 Jun 1.
The primary aim was to investigate whether stenting of post-thrombotic iliofemoral obstruction reduces venous hypertension. The secondary aim was to establish whether improvement in haemodynamic parameters impacts on quality of life.
In this prospective observational study, 12 participants with unilateral post-thrombotic obstruction of the iliac and/or common femoral veins (CFVs) underwent a treadmill stress test with invasive pressure measurements in the CFVs and dorsal foot veins of both affected and non-affected limbs. This was performed the day before and 3 months after stenting the obstructed tract. Paired sample t-tests were used to compare the treatment effect and univariable linear regression analysis to determine the association with improvement in quality of life.
Before treatment, CFV pressure increased 34.8 ± 23.1 mmHg during walking in affected limbs compared with 3.9 ± 5.8 mmHg in non-affected limbs. This pressure rise decreased to 22.3 ± 24.8 mmHg after 3 months follow up compared with a 4.0 ± 6.0 mmHg increase in non-affected limbs (-26.2 mmHg difference; 95% CI -41.2 to -11.3). No such effect was found in the dorsal foot veins. The VEINES-QOL increased 25.3 ± 11.3 points after stenting and was significantly associated with a decrease in CFV pressure rise during walking (regression coefficient 0.4; 95% CI 0.1-0.6).
Stenting of post-thrombotic iliofemoral obstruction significantly reduces venous hypertension in the common femoral vein and correlates with an improvement in the quality of life. Larger studies with a broader range of degree of obstruction need be performed to assess whether pre-stenting pressure measurements can predict post stenting clinical success.
主要目的是探讨血栓后髂股阻塞支架置入是否能降低静脉高压。次要目的是确定血流动力学参数的改善是否会影响生活质量。
在这项前瞻性观察研究中，12 名单侧髂股和/或股总静脉血栓后阻塞患者在受影响和未受影响肢体的股总静脉和背侧足部静脉进行了跑步机压力测试和侵入性压力测量。这是在支架置入阻塞部位之前一天和 3 个月后进行的。采用配对样本 t 检验比较治疗效果，采用单变量线性回归分析确定与生活质量改善的相关性。
在治疗前，受影响肢体在行走时股总静脉压力升高 34.8±23.1mmHg，而未受影响肢体仅升高 3.9±5.8mmHg。这种压力升高在 3 个月随访时下降至 22.3±24.8mmHg，而未受影响肢体仅升高 4.0±6.0mmHg（差异-26.2mmHg；95%置信区间-41.2 至-11.3）。在背侧足部静脉中未发现这种效应。支架置入后 VEINES-QOL 增加 25.3±11.3 分，与行走时股总静脉压力升高的降低显著相关（回归系数 0.4；95%置信区间 0.1-0.6）。
血栓后髂股阻塞支架置入能显著降低股总静脉的静脉高压，并与生活质量的改善相关。需要进行更大范围、阻塞程度更广泛的研究，以评估支架置入前的压力测量是否可以预测支架置入后的临床成功。
