Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Eur J Vasc Endovasc Surg. 2019 Mar;57(3):417-423. doi: 10.1016/j.ejvs.2018.10.009. Epub 2018 Nov 4.
Endovascular treatment is indicated for the treatment of symptomatic thoracic central vein obstruction (TCVO) but is limited by high rates of restenosis and the need for re-intervention. The aim was to assess the safety and mid-term patency of a novel dedicated venous stent for the treatment of TCVO of benign aetiology.
This was a prospective single centre observational study of 20 patients (median age 65 years, 50% male) referred for the treatment of symptomatic chronic (>three months duration) TCVO between May 2016 and January 2018. Balloon angioplasty with implantation of a self expanding nitinol stent (Vici, Boston Scientific, Marlborough, MA, USA) was performed in all patients. Clinical records including demographics, aetiologies and types of TCVO, and procedural details were recorded. Patients were followed up clinically at one, six, and 12 months. Primary and assisted primary patency were reported.
All 20 lesions were total occlusions, of which 55% (n = 11) were de novo, 10% (n = 2) peri-stent restenosis, and 35% (n = 7) in-stent re-occlusion. The aetiology of TCVO was predominantly (95%) because of multiple or prolonged central venous line insertion. The procedural success rate was 90% (18/20) with no procedural complications. The median follow up was 13.5 months. Primary patency was 100% at 6 months. One patient required re-intervention for stent in segment restenosis at 7 months. The assisted primary patency rate was 100% at 12 months.
Endovascular treatment of benign TCVO with the novel dedicated venous stent was safe and effective in relieving obstructive symptoms with excellent one year patency rates.
血管内治疗适用于治疗有症状的胸中心静脉阻塞（TCVO），但存在较高的再狭窄率和需要再次介入的局限性。本研究旨在评估一种新型专用静脉支架治疗良性病因所致 TCVO 的安全性和中期通畅率。
这是一项前瞻性的单中心观察性研究，共纳入 20 例（中位年龄 65 岁，50%为男性）因症状性慢性（>3 个月）TCVO 于 2016 年 5 月至 2018 年 1 月期间就诊的患者。所有患者均接受了球囊血管成形术和自膨式镍钛合金支架（Vici，波士顿科学公司，马萨诸塞州马尔伯勒）植入。记录临床记录，包括人口统计学、TCVO 的病因和类型以及手术细节。患者在 1、6 和 12 个月时进行临床随访。报告了原发性和辅助原发性通畅率。
20 个病变均为完全闭塞，其中 55%（n=11）为新发，10%（n=2）为支架内再狭窄，35%（n=7）为支架内再闭塞。TCVO 的病因主要为（95%）多根或长时间的中心静脉置管。手术成功率为 90%（18/20），无手术相关并发症。中位随访时间为 13.5 个月。6 个月时的原发性通畅率为 100%。1 例患者因支架内节段再狭窄在 7 个月时需要再次介入治疗。12 个月时的辅助原发性通畅率为 100%。
新型专用静脉支架治疗良性 TCVO 的血管内治疗安全有效，可缓解阻塞症状，1 年通畅率高。
