Division of Vascular and Interventional Radiology, University of Virginia School of Medicine, 1215 Lee St., Charlottesville, VA 22908.
Division of Vascular and Interventional Radiology, University of Virginia School of Medicine, 1215 Lee St., Charlottesville, VA 22908.
J Vasc Interv Radiol. 2019 Apr;30(4):572-577. doi: 10.1016/j.jvir.2018.12.003.
To characterize the degree of venous collateralization before and after endovascular therapy and determine the effect of collateralization on success of thrombolysis and rate of repeat intervention in patients with Paget-Schroetter syndrome.
A single-center retrospective study of 37 extremities in 36 patients (mean age, 32.64 y; range, 15-72 y; 24 men) with PSS treated with endovascular therapy from 2007 through 2017 was conducted. Venograms at presentation, after lysis, postoperatively, and at each repeat intervention were graded for venous stenosis, thrombus burden, and collateralization on a 5-point scale. Collateralization was classified as high-grade (9 extremities) or low-grade (28 extremities) based on grading of the venograms at presentation.
Primary technical success rate for endovascular treatment was 100%. Eighty-six percent of patients (32 of 37) underwent thrombolysis, 91% (34 of 37) underwent mechanical thrombectomy, and 83% (30 of 37) underwent balloon angioplasty. Overall primary patency rate was 50% at 12 months. The repeat intervention rate within 12 months was significantly higher for extremities with high- vs low-grade collateralization (89% vs 43%; P = .016). There was a significant decrease in the median grade of collateral severity after initial intervention (2 vs 1; P = .044) and 1 day postoperatively (2 vs 1; P = .040) vs the venogram at presentation.
Severity of venous collateralization on the venogram at presentation of patients with PSS does not appear to affect success of endovascular therapy but may predict long-term patency of affected extremities. Patients in this cohort with severe collateralization on presentation were more likely to need repeat intervention.
描述静脉侧支循环在血管内治疗前后的程度，并确定侧支循环对血栓溶解成功率和复发性 Paget-Schroetter 综合征患者介入治疗率的影响。
对 2007 年至 2017 年期间接受血管内治疗的 36 例（男 24 例，女 12 例；平均年龄 32.64 岁，15-72 岁）37 侧上肢 PSS 患者进行了单中心回顾性研究。在出现、溶解后、手术后和每次重复介入时，根据静脉造影的静脉狭窄、血栓负荷和侧支循环程度进行 5 分制评分。根据初始静脉造影的分级，将侧支循环分为高分级（9 侧）和低分级（28 侧）。
血管内治疗的初始技术成功率为 100%。86%的患者（37 例中的 32 例）行溶栓治疗，91%（37 例中的 34 例）行机械血栓切除术，83%（37 例中的 30 例）行球囊血管成形术。12 个月时总的一期通畅率为 50%。12 个月内，高分级侧支循环与低分级侧支循环的重复介入率差异有统计学意义（89%比 43%；P =.016）。初次干预后（2 分比 1 分；P =.044）和术后第 1 天（2 分比 1 分；P =.040），中位数侧支严重程度分级均明显降低。
PSS 患者静脉造影初始侧支循环的严重程度似乎不会影响血管内治疗的成功率，但可能预测受影响肢体的长期通畅率。在该队列中，初诊时侧支循环严重的患者更可能需要重复介入。
