Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Soochow, Jiangsu, China.
J Thromb Thrombolysis. 2019 Jan;47(1):134-139. doi: 10.1007/s11239-018-1757-4.
Stent implantation is the common treatment method for iliac vein (IV) occlusion. IV stents usually enter into the inferior vena cava (IVC) to partially or completely cover the contralateral IV, but it is still uncertain whether this can increase the risk of thrombosis in the contralateral IV. The purpose of this study was to investigate the effect of the stent position on the bilateral IVs patency. A total of 261 patients with symptomatic IV lesions, including 177 patients with non-thrombotic iliac vein lesions (NIVLs) and 84 patients with thrombotic iliac vein lesions (TIVLs), were implanted with IV stents between July 2007 and June 2017. The data of these patients were retrospectively studied. The follow-up time was 6-114 months, and the median time was 62 months. A total of 183 cases had stenting into the IVC for more than 5 mm. The incidence of thrombosis in the contralateral IV was only 0.55% (1/183). A total of 17 short- and long-term cumulative cases had ipsilateral thrombosis on the stent side. There was no significant difference between the incidence of patients (8.79%, 7/78) with stenting into the IVC for less than 5 mm and those with more than 5 mm (5.46%, 10/183, P = 0.287). However, in the TIVLs group, the incidence of ipsilateral thrombosis between stenting positions less than 5 mm (29.6%, 8/27) and those more than 5 mm (8.77%, 5/57) was significantly different (P = 0.022). Stent implantation for NIVLs had an excellent long-term patency rate; the primary patency rate and the assisted primary patency rate were 97.7% and 100%, respectively. The entry of IV stents into the IVC was safe and had a very low incidence of thrombosis in the contralateral vein. Stenting less into the IVC increased the incidence of thrombosis in the ipsilateral vein, especially among thrombotic cases. Treatment of NIVLs using stent implantation had a better long-term patency rate. This principle plays an important guiding role in the endovascular therapy of IV lesions.
支架植入术是髂静脉（IV）闭塞的常用治疗方法。IV 支架通常进入下腔静脉（IVC），部分或完全覆盖对侧 IV，但仍不确定这是否会增加对侧 IV 血栓形成的风险。本研究旨在探讨支架位置对双侧 IV 通畅性的影响。
共对 261 例有症状的 IV 病变患者（包括 177 例非血栓性髂静脉病变（NIVL）和 84 例血栓性髂静脉病变（TIVL））进行了 IV 支架植入，这些患者的临床数据均进行了回顾性分析。随访时间为 6-114 个月，中位时间为 62 个月。共有 183 例支架进入 IVC 超过 5mm。对侧 IV 血栓形成的发生率仅为 0.55%（1/183）。共有 17 例短、长期累计支架侧同侧血栓形成。支架进入 IVC 小于 5mm 的患者（8.79%，7/78）与支架进入 IVC 大于 5mm 的患者（5.46%，10/183，P=0.287）的发生率无显著差异。然而，在 TIVL 组中，支架位置小于 5mm（29.6%，8/27）和大于 5mm（8.77%，5/57）的同侧血栓形成发生率差异有统计学意义（P=0.022）。NIVL 支架植入术具有极好的长期通畅率，初始通畅率和辅助初始通畅率分别为 97.7%和 100%。IV 支架进入 IVC 是安全的，对侧静脉血栓形成的发生率非常低。支架进入 IVC 较少会增加同侧静脉血栓形成的发生率，尤其是在血栓形成的情况下。支架植入术治疗 NIVL 的长期通畅率更好。这一原则在 IV 病变的血管内治疗中具有重要的指导作用。
