Department of Radiology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305.
Department of Radiology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305.
J Vasc Interv Radiol. 2020 Feb;31(2):251-259.e2. doi: 10.1016/j.jvir.2019.06.011. Epub 2019 Sep 18.
To study short-term and long-term outcomes of lower extremity venous stents placed at a single center and to characterize changes in vein diameter achieved by stent placement.
A database of all patients who received lower extremity venous stents between 1996 and 2018 revealed 1,094 stents were placed in 406 patients (172 men, 234 women; median age, 49 y) in 513 limbs, including patients with iliocaval stents (9.4% acute thrombosis, 65.3% chronic thrombosis, 25.3% nonthrombotic lesions). Primary, primary assisted, and secondary patency rates were assessed for lower extremity venous stents at 1, 3, and 5 years using Kaplan-Meier analyses and summary statistics. Subset analyses and Cox regression were performed to identify risk factors for patency loss. Vein diameters and Villalta scores before and up to 12 months after stent placement were compared. Complication and mortality rates were calculated.
Primary, primary assisted, and secondary patency rates at 5 years were 57.3%, 77.2%, and 80.9% by Kaplan-Meier methods and 78.6%, 90.3%, and 92.8% by summary statistics. Median follow-up was 199 days (interquartile range, 35.2-712.0 d). Patency rates for the subset of patients (n = 46) with ≥ 5 years of follow-up (mean ± SD 9.1 y ± 3.4) were nearly identical to cohort patency rates at 5 years. Patients with inferior vena cava stent placement (hazard ratio 2.11, P < .0001) or acute thrombosis (hazard ratio 3.65, P < .0001) during the index procedure had significantly increased risk of losing primary patency status. Vein diameters were significantly greater after stent placement. There were no instances of stent fracture, migration, or structural deformities. In patients with chronic deep vein thrombosis, Villalta scores significantly decreased after stent placement (from 15.7 to 7.4, P < .0001). Perioperative mortality was < 1%, and major perioperative complication rate was 3.7%.
Cavo-ilio-femoral stent placement for venous occlusive disease achieves improvement of vein disease severity scores, increase in treated vein diameters, and satisfactory long-term patency rates.
研究单中心下肢静脉支架置入的短期和长期效果，并描述支架置入后静脉直径的变化。
对 1996 年至 2018 年间所有接受下肢静脉支架置入术的患者的数据库进行分析，共发现 406 例患者（172 例男性，234 例女性；中位年龄 49 岁）513 条肢体接受了静脉支架置入术，包括髂股静脉支架（9.4%急性血栓形成，65.3%慢性血栓形成，25.3%非血栓性病变）。采用 Kaplan-Meier 分析和汇总统计评估下肢静脉支架的 1、3 和 5 年的一期通畅率、一期辅助通畅率和二期通畅率。进行亚组分析和 Cox 回归分析，以确定通畅率丧失的风险因素。比较支架置入前后 12 个月内的静脉直径和 Villalta 评分。计算并发症和死亡率。
Kaplan-Meier 法和汇总统计法 5 年的一期通畅率、一期辅助通畅率和二期通畅率分别为 57.3%、77.2%和 80.9%和 78.6%、90.3%和 92.8%。中位随访时间为 199 天（四分位距 35.2-712.0 天）。在随访时间≥5 年的 46 例患者亚组中（平均±标准差 9.1 岁±3.4 岁），其通畅率与队列 5 年时的通畅率几乎相同。支架置入术中下腔静脉支架置入（风险比 2.11，P<.0001）或急性血栓形成（风险比 3.65，P<.0001）的患者，一期通畅率丧失的风险显著增加。支架置入后静脉直径明显增大。无支架断裂、迁移或结构变形。在慢性深静脉血栓形成患者中，支架置入后 Villalta 评分显著降低（从 15.7 分降至 7.4 分，P<.0001）。围手术期死亡率<1%，主要围手术期并发症发生率为 3.7%。
静脉阻塞性疾病的腔静脉-髂股静脉-股静脉支架置入术可改善静脉疾病严重程度评分，增加治疗静脉直径，并获得满意的长期通畅率。
