Tosenovsky Patrik
Department of Vascular & Endovascular Surgery, Perth, Western Australia, Australia.
Ann Vasc Surg. 2019 Aug;59:208-216. doi: 10.1016/j.avsg.2018.12.082. Epub 2019 Mar 1.
The aim of the study was to assess results of interventions for iliocaval obstruction or compression in patient with acute and chronic venous disease.
Patients with chronic venous insufficiency (CVI) C3-C6 (Clinical, Etiology, Anatomy, Pathology - classification of venous insufficiency) and acute deep venous thrombosis were assessed by ultrasound scan, computed tomography, venography, and/or intravascular ultrasound, and if an obstruction in their iliocaval or iliofemoral segments were confirmed, they underwent venoplasty and stenting. Acute deep venous thrombosis cases were treated with pharmacomechanical and/or catheter-directed thrombolysis and residual obstruction was then stented.
One hundred eighteen consecutive limbs were treated between October 2011 and December 2017. Thirty-two limbs had an active ulcer (27%), 27 limbs had healed ulcer or advanced skin changes (23%), 39 limbs had swelling with or without other symptoms of CVI (33%), 15 limbs had acute symptomatic deep venous thrombosis (13%), and the residual 5 iliac vein cases were causing pelvic congestion syndrome (4%). Patency rates of the stents in acute cases were 84.6%, 76.9%, 76.9%, and in chronic cases (combined thrombotic and nonthrombotic) 93.1%, 91%, and 89.9% in 3, 6, and 12 months, respectively. A relief of symptoms was achieved in 81.5 % of limbs at some stage during the first 12 months (most of them within the first 3 months), although at the end of this period only 59.3% remained free of symptoms. There was no limb loss and no mortality within 30 days from the intervention.
Iliocaval and iliofemoral venoplasty and stenting in both acute and chronic obstruction cases can be performed safely with good patency rates and reasonable improvement of symptoms of CVI.
本研究的目的是评估针对急慢性静脉疾病患者的髂股静脉阻塞或受压的干预结果。
对慢性静脉功能不全（CVI）C3 - C6级（临床、病因、解剖、病理——静脉功能不全分类）和急性深静脉血栓形成的患者进行超声扫描、计算机断层扫描、静脉造影和/或血管内超声检查，如果确认其髂股或髂总静脉段存在阻塞，则接受静脉成形术和支架置入术。急性深静脉血栓形成病例采用药物机械和/或导管直接溶栓治疗，然后对残余阻塞进行支架置入。
2011年10月至2017年12月期间，连续治疗了118条肢体。32条肢体有活动性溃疡（27%），27条肢体有愈合的溃疡或严重的皮肤改变（23%），39条肢体有肿胀，伴有或不伴有CVI的其他症状（33%），15条肢体有急性症状性深静脉血栓形成（13%），其余5例髂静脉病例导致盆腔充血综合征（4%）。急性病例中支架在术后3个月、6个月和12个月时的通畅率分别为84.6%、76.9%、76.9%，慢性病例（合并血栓形成和非血栓形成）分别为93.1%、91%和89.9%。在最初12个月的某个阶段，81.5%的肢体症状得到缓解（大多数在最初3个月内），尽管在此期间结束时只有59.3%的肢体无症状。干预后30天内无肢体丢失及死亡病例。
在急性和慢性阻塞病例中，髂股静脉和髂总静脉成形术及支架置入术均可安全进行，通畅率良好，CVI症状有合理改善。
