Grøtta Ole, Enden Tone, Sandbæk Gunnar, Gjerdalen Gard Filip, Slagsvold Carl-Erik, Bay Dag, Kløw Nils-Einar, Rosales Antonio
1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway.
CVIR Endovasc. 2018;1(1):29. doi: 10.1186/s42155-018-0038-9. Epub 2018 Nov 16.
To assess the technical success, patency, and clinical outcome, following assessment of inflow and infrainguinal endovenous stent placement in patients with iliofemoral post-thrombotic obstruction with infrainguinal involvement.
A retrospective analysis of 39 patients with iliofemoral post-thrombotic venous obstruction accepted for infrainguinal stent placement in the period November 2009-December 2016. The clinical status was categorized according to the Clinical Etiological Anatomical Pathophysiological (CEAP) classification and symptom severity was assessed using Venous Clinical Severity Score (VCSS). The inflow was categorized as "good", "fair", or "poor" depending on vein caliber and extent of post-thrombotic changes in the inflow vessel(s). Stent patency was assessed by duplex ultrasound. Median follow-up was 44 months (range 2-90 months).
Stent placement was successful in all 39 patients. Primary patency after 24 months was 78%. Thirty of 39 patients (77%) had open stents at final follow-up. Re-interventions were performed in four patients and included catheter-directed thrombolysis (CDT) in all and adjunctive stenting in two. Twenty-eight of 39 patients (72%) reported a sustained clinical improvement. Patients with "good" inflow had better patency compared to those with "fair"/"poor" ( = 0.01). One patient experienced acute contralateral iliofemoral thrombosis; this segment was successfully treated with CDT and stenting. No other complications required intervention.
Infrainguinal endovenous stent placement was a feasible and safe treatment with good patency and clinical results, and should be considered in patients with substantial symptoms from post-thrombotic obstructions with infrainguinal involvement. Stents with good inflow have better patency and inflow assessment is essential in deciding the optimal stent landing zone.
在评估患有股腘静脉血栓形成后梗阻且累及股腘静脉的患者的流入道及股腘静脉内支架置入情况后，评估技术成功率、通畅率及临床结局。
对2009年11月至2016年12月期间接受股腘静脉内支架置入的39例股腘静脉血栓形成后静脉梗阻患者进行回顾性分析。根据临床病因解剖病理生理（CEAP）分类对临床状态进行分类，并使用静脉临床严重程度评分（VCSS）评估症状严重程度。根据静脉管径和流入道血管血栓形成后改变的程度，将流入道分为“良好”、“中等”或“较差”。通过双功超声评估支架通畅情况。中位随访时间为44个月（范围2 - 90个月）。
39例患者支架置入均成功。24个月时的初始通畅率为78%。39例患者中有30例（77%）在末次随访时支架通畅。4例患者进行了再次干预，均包括导管直接溶栓（CDT），其中2例进行了辅助支架置入。39例患者中有28例（72%）报告临床症状持续改善。与流入道“中等”/“较差”的患者相比，流入道“良好”的患者通畅率更高（P = 0.01）。1例患者发生急性对侧股腘静脉血栓形成；该节段通过CDT和支架置入成功治疗。无其他并发症需要干预。
股腘静脉内支架置入是一种可行且安全的治疗方法，具有良好的通畅率和临床效果，对于有明显症状的股腘静脉血栓形成后梗阻患者应考虑采用。流入道良好的支架通畅率更高，评估流入道对于确定最佳支架放置区域至关重要。
