Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
J Vasc Surg Venous Lymphat Disord. 2020 Mar;8(2):231-236. doi: 10.1016/j.jvsv.2019.04.015. Epub 2019 Aug 13.
Proximal venous outflow obstruction (PVOO) in the iliac veins and superficial venous disease are inter-related in ways not fully understood. We observed among our patients undergoing vein stent placement for PVOO a significant number having had prior endovenous thermal ablations (EVTA) in their history. This study was undertaken to better characterize these patients and develop an algorithm in their management.
In a combined retrospective and prospective data registry of 682 patients who underwent vein stent placement for chronic PVOO at a single institution from March 2013 to November 2017, 100 limbs of 99 patients (14.5% of all patients) had a history of EVTA or other superficial venous procedures before their vein stenting. Limbs with dilated truncal veins on ultrasound examination or limbs that underwent poststent EVTA or superficial venous procedures were excluded. The mean age of these 99 patients was 60.2 years (range, 28-88 years; standard deviation, 13.855). Fifty-one percent of the patients were male. The most common presenting symptom of the patient cohort was edema (n = 59), followed by venous-related skin changes (n = 22).
Bilateral stents were performed in 58%, with a mean number of 2.06 stents per patient. EVTA was the primary superficial vein procedure in 97%. Bilateral EVTA were performed in 53% and unilateral EVTA in 47%. The mean time between the first EVTA to vein stenting was 1202.7 days. Patients were followed at 30 days, 90 days, 6 months, 1 year, and >1 year. The outcome for each patient at each postoperative visit was compared with preoperative parameters (subject's assessment, physical examination, and provider assessment) and was scored as follows: -1 (worse than preoperative), 0 (no change), +1 (mildly improved), +2 (significantly improved), or +3 (completely recovered). The mean outcome score at 30 days was 1.63 (84 patients), 2.05 at 90 days (62 patients), 2.09 at 6 months (74 patients), 1.93 at 1 year (54 patients), and 1.97 at >1 year (39 patients).
Approximately 15% of patients undergoing vein stent placement for chronic PVOO have an antecedent history of superficial venous disease and EVTA. PVOO should be considered and the patient evaluated accordingly if symptoms persisted or recurred after EVTA. Vein stent placement among these patients with PVOO will result in further symptomatic relief, but complete symptomatic relief is not observed in everyone. The algorithm for the management of these patients warrants further investigation.
髂静脉近端静脉流出阻塞（PVOO）和浅表静脉疾病之间存在相互关联，但目前尚不完全清楚其具体的关联方式。我们在对因 PVOO 接受静脉支架置入术的患者中观察到，其中相当一部分患者既往有静脉内热消融术（EVTA）史。本研究旨在更好地描述这些患者，并制定其管理方案。
在一家机构 2013 年 3 月至 2017 年 11 月期间，对 682 例因慢性 PVOO 接受静脉支架置入术的患者进行了回顾性和前瞻性数据登记，其中 100 条肢体（99 例患者，占所有患者的 14.5%）在接受静脉支架置入术前有 EVTA 或其他浅表静脉手术史。排除超声检查显示主干静脉扩张或支架置入后行 EVTA 或浅表静脉手术的肢体。这 99 例患者的平均年龄为 60.2 岁（范围，28-88 岁；标准差，13.855）。51%的患者为男性。该患者队列的最常见表现症状为水肿（n=59），其次为静脉相关皮肤改变（n=22）。
58%的患者行双侧支架置入，平均每位患者置入 2.06 个支架。EVTA 是主要的浅表静脉手术方式，占 97%。双侧 EVTA 占 53%，单侧 EVTA 占 47%。首次 EVTA 至静脉支架置入的平均时间为 1202.7 天。患者在术后 30 天、90 天、6 个月、1 年和>1 年时进行随访。每位患者在每次术后就诊时的结局与术前参数（患者自评、体格检查和医生评估）进行比较，并按以下评分：-1（比术前差）、0（无变化）、+1（轻度改善）、+2（明显改善）或+3（完全恢复）。术后 30 天的平均结局评分为 1.63（84 例患者），90 天为 2.05（62 例患者），6 个月为 2.09（74 例患者），1 年为 1.93（54 例患者），>1 年为 1.97（39 例患者）。
约 15%因慢性 PVOO 接受静脉支架置入术的患者有浅表静脉疾病和 EVTA 的既往史。如果 EVTA 后症状持续或复发，应考虑存在 PVOO，并相应评估患者。这些存在 PVOO 的患者行静脉支架置入术可进一步缓解症状，但并非所有人的症状均能完全缓解。这些患者的管理方案需要进一步研究。
