Department of Vascular Surgery, 4th Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Vascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Eur J Vasc Endovasc Surg. 2019 Mar;57(3):407-416. doi: 10.1016/j.ejvs.2018.09.022. Epub 2018 Nov 7.
Stent placements are considered as a treatment for post-thrombotic syndrome (PTS) with iliofemoral obstruction, but the application of these iliofemoral venous stents has also caused a lot of controversy. The purpose of this systematic review and meta-analysis was to summarise the efficacy and safety of venous stents in PTS with obstruction in iliofemoral venous segments.
MEDLINE, EMBASE, and the Cochrane Central Register for Controlled Trials databases and key references were searched up to 15 January 2018. The main relevant outcomes included technical success, peri-operative complications, symptom resolution, a change of symptom scores, and long-term patency of the stents.
Overall, 504 limbs of 489 patients from seven studies were included in this study. A GRADE assessment showed the quality of the evidence was "very low" for 11 relevant outcomes. The technical success rate was 95%. The pooled rate of complications including 30 day thrombotic event, per-operative venous injury, and back pain was 3.4%, 18.14%, and 52%, respectively. The rates of ulcer healing, pain and oedema relief were 75.66%, 52%, and 42%, respectively. The primary, assisted primary and secondary patency rates were 83.36%, 90.59%, and 94.32%, respectively, at 12 months and 67.98%, 82.26%, and 86.10%, respectively, at 36 months.
Endovenous stenting has the potential to be effective and has a low risk of peri-operative complications. The quality of evidence to support this treatment is very low. Endovenous iliofemoral stenting should be considered a treatment option for PTS with iliofemoral obstruction.
支架置入被认为是治疗髂股静脉阻塞后血栓后综合征（PTS）的一种方法，但这些髂股静脉支架的应用也引起了很多争议。本系统评价和荟萃分析的目的是总结静脉支架在髂股静脉节段阻塞性 PTS 中的疗效和安全性。
检索 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册数据库以及主要参考文献，检索时间截至 2018 年 1 月 15 日。主要相关结局包括技术成功率、围手术期并发症、症状缓解、症状评分变化和支架的长期通畅率。
共有来自 7 项研究的 489 例 504 条肢体纳入本研究。GRADE 评估显示 11 项相关结局的证据质量为“极低”。技术成功率为 95%。并发症包括 30 天血栓形成事件、术中静脉损伤和背痛的合并发生率分别为 3.4%、18.14%和 52%。溃疡愈合率、疼痛缓解率和水肿缓解率分别为 75.66%、52%和 42%。12 个月时的主要、辅助主要和次要通畅率分别为 83.36%、90.59%和 94.32%，36 个月时分别为 67.98%、82.26%和 86.10%。
静脉内支架置入术可能有效，且围手术期并发症风险低。支持这种治疗方法的证据质量非常低。静脉内髂股静脉支架置入术应被视为髂股静脉阻塞性 PTS 的一种治疗选择。
