The RANE Center for Venous and Lymphatic Diseases, St. Dominic Hospital, Jackson, Miss.
The RANE Center for Venous and Lymphatic Diseases, St. Dominic Hospital, Jackson, Miss.
J Vasc Surg Venous Lymphat Disord. 2019 Mar;7(2):195-202. doi: 10.1016/j.jvsv.2018.10.001. Epub 2018 Dec 13.
May-Thurner syndrome (MTS) patients with lifestyle-limiting symptoms undergo stenting of the iliac vein for relief of compressive disease. The impact of degree of stenosis on clinical symptoms and outcomes after stenting is unknown and examined in our study.
Retrospective review of contemporaneously entered data of 202 patients who underwent stenting for MTS between 2005 and 2011 was performed. Classification into three groups based on luminal area obtained by intraoperative intravascular ultrasound interrogation of the involved femoroiliocaval segments was carried out. Normal luminal diameters and areas were defined as 12 mm and 125 mm, 14 mm and 150 mm, and 16 mm and 200 mm in the common femoral, external iliac, and common iliac veins, respectively. Mild (<60%), moderate (60%-89%), and severe (>90%) compression groups were defined using the normal values noted previously and observed after stenting to evaluate outcomes. Kaplan-Meier analysis was done to assess primary, primary assisted, and secondary patencies. Visual analog scale for pain scores, grade of swelling, and Venous Clinical Severity Score (VCSS) before and after stenting at 6, 24, and 48 months were analyzed using paired t-test and Tukey test. Logistic regression was used to gauge the impact of multiple variables including degree of stenosis on stent reintervention.
There were 55 patients who had mild, 87 patients who had moderate, and 60 patients who had severe iliac vein compression. Baseline demographic characteristics and comorbidities were similar across all groups. In addition, there was no statistically significant difference in median baseline visual analog scale score, grade of swelling, and VCSS among the groups. Compression was treated with angioplasty and stenting encompassing all areas of disease as determined by intravascular ultrasound. Stent technique involved use of Wallstent (Boston Scientific, Marlborough, Mass) only in 183 patients and Wallstent-Z stent (Cook Medical, Bloomington, Ind) combination in the remainder. No difference in median stent patency was noted on follow-up. Clinically, at 48 months, a statistically significant recurrence of pain, swelling, and worsening of VCSS were noted in the severe stenosis group but not in the other two groups. No variable was noted to have an impact on stent reintervention.
Severity of MTS stenosis is not a predictor of initial clinical symptoms. Long term, patients with ≥90% initial MTS stenosis experience recurrence of symptoms. The degree of iliac venous stenosis does not appear to affect stent patency. Such information will help counsel patients before intervention.
患有 May-Thurner 综合征（MTS）且生活受限症状的患者，接受髂静脉支架置入术以缓解压迫性疾病。本研究旨在探讨狭窄程度对支架置入术后临床症状和结局的影响。
回顾性分析 2005 年至 2011 年间接受 MTS 支架置入术的 202 例患者的同期录入数据。根据术中血管内超声检查受累股髂静脉段获得的管腔面积，将患者分为三组。在股总、外髂和髂总静脉中，正常管腔直径和面积分别定义为 12mm 和 125mm、14mm 和 150mm、16mm 和 200mm。采用先前记录的正常值和支架置入后观察到的值，将狭窄<60%、60%-89%和>90%的轻度、中度和重度压迫组定义为观察结局。采用 Kaplan-Meier 分析评估主要、辅助主要和次要通畅率。采用配对 t 检验和 Tukey 检验分析支架置入前后 6、24 和 48 个月的疼痛评分、肿胀程度和静脉临床严重程度评分（VCSS）的视觉模拟量表。采用逻辑回归评估包括狭窄程度在内的多个变量对支架再干预的影响。
轻度组 55 例，中度组 87 例，重度组 60 例。所有组的基线人口统计学特征和合并症相似。此外，各组的基线视觉模拟量表评分中位数、肿胀程度和 VCSS 中位数均无统计学差异。根据血管内超声检查，所有病变部位均行血管成形术和支架置入术。支架技术仅在 183 例患者中使用 Wallstent（波士顿科学公司，马萨诸塞州马尔伯勒），其余患者使用 Wallstent-Z 支架（库克医疗公司，印第安纳州布鲁明顿）联合治疗。随访时中位支架通畅率无差异。临床随访 48 个月时，重度狭窄组疼痛、肿胀和 VCSS 恶化的复发有统计学意义，但其他两组无统计学意义。未发现任何变量对支架再干预有影响。
MTS 狭窄的严重程度不是初始临床症状的预测因素。长期来看，初始 MTS 狭窄≥90%的患者症状复发。髂静脉狭窄程度似乎不会影响支架通畅率。这些信息将有助于在干预前为患者提供咨询。
