Division of Vascular Surgery, NYU Lutheran Medical Center, Brooklyn, NY.
Division of Vascular Surgery, NYU Lutheran Medical Center, Brooklyn, NY.
J Vasc Surg Venous Lymphat Disord. 2018 Jul;6(4):457-463. doi: 10.1016/j.jvsv.2018.02.004.
Midterm patency results of iliac vein stents placed for nonthrombotic iliac vein lesions (NIVLs) are not widely known. Previously published studies involving large series of patients with iliac vein stent placement have failed to clearly demonstrate the outcomes for patients with NIVLs and advanced disease. To further study this issue, we reviewed our series of 268 iliac vein stents placed for NIVLs.
Retrospective analysis was performed of 210 patients who underwent common or external iliac vein angioplasty and stent placement procedures between January 2013 and December 2014. Only patients with Clinical, Etiology, Anatomy, and Pathophysiology classification scores of C3, C4, or C5 were included. Patients were excluded if they had either active ulcer disease or signs of post-thrombotic lesions at initial venography or intravascular ultrasound (IVUS). Ultrasound-guided puncture was performed of the femoral or common femoral vein at the discretion of the surgeon. This was followed by ascending venography. IVUS was used in cases in which a definite stenosis was not appreciated on initial ascending venography. Balloon angioplasty and stents were applied across lesions. After the procedure, patients were instructed to use clopidogrel 75 mg daily. Patency of the stents was assessed during a follow-up visit with abdominal venous duplex ultrasound scans. The length of the patients' follow-up and stent patency rates were based on the last previous duplex ultrasound scan available.
A total of 268 procedures were performed in 210 patients. Bilateral lower extremity stent placements were required in 58 patients; 173 (64.6%) procedures were performed in women. The average age of our patients was 72 ± 15 (standard deviation) years. Of the 268 procedures, 144 (53.7%) were performed in the left lower extremity. The Clinical, Etiology, Anatomy, and Pathophysiology classification of lower extremity venous disease was 58%, 30%, and 12% for C3, C4, and C5, respectively. Our average follow-up period was 437 days (median, 499 days; range, 1-1060 days). Patients were observed for >6 months, 1 year, and 2 years in 71.3%, 57.1%, and 28.7% of cases, respectively. During this period, 4 of the 268 (1.5%) limbs experienced in-stent thrombosis. Primary stent patency of 98.7%, 98.3%, and 97.9% was noted at 6 months, 1 year, and 2 years of follow-up, respectively.
Our midterm patency rates for iliac vein stents placed in patients with advanced chronic venous disease demonstrated excellent (98.5%) results. Furthermore, with IVUS assistance, we have clearly documented the average area of iliac venous segments as well as the most common locations of the stenoses.
髂静脉支架置入治疗非血栓性髂静脉病变（NIVL）的中期通畅率尚未得到广泛认可。先前发表的涉及大量髂静脉支架置入患者的研究未能明确显示 NIVL 和晚期疾病患者的结局。为了进一步研究这个问题，我们回顾了我们的 268 例 NIVL 髂静脉支架置入系列。
对 2013 年 1 月至 2014 年 12 月期间接受髂总或髂外动脉血管成形术和支架置入术的 210 例患者进行回顾性分析。仅纳入临床、病因、解剖和病理生理学（CEAP）评分 C3、C4 或 C5 的患者。如果初始静脉造影或血管内超声（IVUS）显示存在活动性溃疡病或血栓后病变迹象，则将患者排除在外。根据外科医生的判断，经股或股总静脉行超声引导穿刺。然后进行上行静脉造影。如果初始上行静脉造影未发现明确狭窄，则使用 IVUS。球囊血管成形术和支架应用于病变部位。术后，嘱患者每日服用氯吡格雷 75mg。通过腹部静脉双功能超声扫描在随访时评估支架通畅情况。患者的随访时间和支架通畅率基于最后一次可用的上次双功能超声扫描。
210 例患者共进行了 268 例手术。58 例患者需要双侧下肢支架置入；173 例（64.6%）手术为女性患者。我们患者的平均年龄为 72±15 岁（标准差）。268 例手术中，144 例（53.7%）为左侧下肢。下肢静脉疾病的 CEAP 分类为 58%、30%和 12%分别为 C3、C4 和 C5。我们的平均随访时间为 437 天（中位数，499 天；范围，1-1060 天）。>6 个月、1 年和 2 年分别观察到 71.3%、57.1%和 28.7%的病例。在此期间，268 例肢体中有 4 例（1.5%）发生支架内血栓形成。6 个月、1 年和 2 年的支架通畅率分别为 98.7%、98.3%和 97.9%。
我们对晚期慢性静脉疾病患者进行的髂静脉支架置入的中期通畅率显示出优异的（98.5%）结果。此外，在 IVUS 辅助下，我们清楚地记录了髂静脉节段的平均面积以及狭窄最常见的位置。
