Zhang Xicheng, Huang Wennuo, Yu Huiming, Chen Yong, Liu Jiaxin, Gao Qihang, Zhao Dengqiu
Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China.
The third people's hospital of Huizhou, Guangdong, China.
Vasc Endovascular Surg. 2019 Nov;53(8):644-648. doi: 10.1177/1538574419872318. Epub 2019 Aug 27.
Stenting is the preferred treatment for iliac vein lesions. For the treatment of occlusions in the junction of the iliac vein and the inferior vena cava (IVC), the stent needs to be positioned in the IVC to cover the lesion. However, the pathological changes in the contralateral iliac vein due to stent coverage on its ostium remain unclear. We observed the patency of the contralateral iliac vein via animal experiments.
The stents were placed in the left iliac vein and extended into the IVC in 8 beagle dogs. Doppler ultrasonography, angiography, and histopathological examination were used to assess the patency and histopathological changes in the contralateral iliac vein.
Angiography showed patency of the contralateral iliac vein and no sign of thrombosis or stenosis. Twelve months after stenting, Doppler ultrasonography showed a stenotic change in the ostium of the contralateral iliac vein. The histopathological examination showed that the stent strut at the ostium of the contralateral iliac vein was mostly covered by the intima, and the cross-sectional stenosis rate was greater than 60%.
The coverage of the iliac vein stent on the ostium of the contralateral iliac vein does not cause complete occlusion of the contralateral vein but can cause significant stenosis at the ostium of the contralateral iliac vein, which is considered to be a potential risk factor for thrombosis.
支架置入是髂静脉病变的首选治疗方法。对于髂静脉与下腔静脉（IVC）交界处闭塞的治疗，支架需要放置在下腔静脉以覆盖病变。然而，支架覆盖对侧髂静脉开口处导致的对侧髂静脉病理变化尚不清楚。我们通过动物实验观察对侧髂静脉的通畅情况。
在8只比格犬的左髂静脉放置支架并延伸至下腔静脉。采用多普勒超声、血管造影和组织病理学检查评估对侧髂静脉的通畅情况和组织病理学变化。
血管造影显示对侧髂静脉通畅，无血栓形成或狭窄迹象。支架置入12个月后，多普勒超声显示对侧髂静脉开口处有狭窄改变。组织病理学检查显示，对侧髂静脉开口处的支架小梁大多被内膜覆盖，横断面狭窄率大于60%。
髂静脉支架覆盖对侧髂静脉开口处不会导致对侧静脉完全闭塞，但可导致对侧髂静脉开口处明显狭窄，这被认为是血栓形成的潜在危险因素。
