Department of Vascular Surgery, Zhongshan Hospital, Affiliated to Fudan University, Shanghai, People's Republic of China.
Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Affiliated to Fudan University, Shanghai, People's Republic of China.
J Vasc Surg Venous Lymphat Disord. 2020 Jan;8(1):74-83. doi: 10.1016/j.jvsv.2019.08.009. Epub 2019 Nov 5.
Lower limb chronic venous disease (CVD), resulting from iliac vein compression syndrome (IVCS), manifests as a series of symptoms ranging from varicose veins to venous ulcerations. Stent implantation has been considered an effective treatment method; however, the management of CVD has rarely been reported. In the present study, we evaluated the treatment and outcomes of patients with CVD.
We performed a retrospective cohort study of patients with severe iliac vein stenosis with lower limb CVD. The patients were divided into two groups: group 1 had received stenting alone (n = 42), and group 2 had received stenting and high ligation/endovenous laser treatment (n = 29). We evaluated the clinical outcomes using the Venous Clinical Severity Score and visual analog scale, and assessed the quality of life (QoL) using the Chronic Venous Disease QoL questionnaire at a median follow-up point of 15 months (range, 6-25 months).
In our cohort, the prevalence rate of nonthrombotic IVCS (NIVCS) was 11.7% (98 of 838 patients). The technical success rate was 100%, without severe complications. During the study period, three group 1 patients and two group 2 patients were lost to follow-up. The overall patency rate in the patients with NIVCS during a mean follow-up period of 15.0 months (range, 6-25 months) was 94.4%. For patients with a Clinical, Etiology, Anatomy, Pathophysiology (CEAP) clinical class of <4, all parameters showed similar improvements in the two groups, except for the disappearance of varicose veins. However, in patients with a CEAP clinical class of ≥4, the combination therapy significantly improved their QoL. The Venous Clinical Severity Score reduction was 4.64 ± 1.72 in group 1 and 11.89 ± 1.82 in group 2 (P < .01). Pain, scored using the visual analog scale, demonstrated a decrease from 4.41 to 2.52 (P < .05) in group 1 and 4.71 to 0.53 (P < .01) in group 2. The relief rate of stasis dermatitis in groups 1 and 2 was 26.9% and 90.5%, respectively (P < .05), and the venous ulceration healing rate was 16.7% and 87.5%, respectively (P < .05).
The prevalence of NIVCS should not be overlooked. The proposed combination treatment is an effective therapeutic strategy for patients with NIVCS and advanced CVD (CEAP clinical class, ≥4) during short-term follow-up.
髂静脉压迫综合征（IVCS）导致的下肢慢性静脉疾病（CVD）表现为一系列症状，从静脉曲张到静脉溃疡不等。支架植入被认为是一种有效的治疗方法；然而，CVD 的管理很少有报道。在本研究中，我们评估了 CVD 患者的治疗和结果。
我们对患有严重髂静脉狭窄伴下肢 CVD 的患者进行了回顾性队列研究。患者分为两组：组 1 仅接受支架植入（n=42），组 2 接受支架植入和高位结扎/静脉内激光治疗（n=29）。我们使用静脉临床严重程度评分和视觉模拟评分评估临床结果，并在中位数随访 15 个月（6-25 个月）时使用慢性静脉疾病生活质量问卷评估生活质量（QoL）。
在我们的队列中，非血栓性 IVCS（NIVCS）的患病率为 11.7%（838 例患者中的 98 例）。技术成功率为 100%，无严重并发症。在研究期间，组 1 中有 3 例患者和组 2 中有 2 例患者失访。在平均随访 15.0 个月（6-25 个月）期间，NIVCS 患者的总体通畅率为 94.4%。对于 CEAP 临床分级<4 的患者，两组所有参数均显示出相似的改善，除了静脉曲张的消失。然而，对于 CEAP 临床分级≥4 的患者，联合治疗显著改善了他们的 QoL。组 1 的静脉临床严重程度评分降低了 4.64±1.72，组 2 降低了 11.89±1.82（P<.01）。组 1 的疼痛评分（视觉模拟评分）从 4.41 降至 2.52（P<.05），组 2 从 4.71 降至 0.53（P<.01）。组 1 和组 2 的淤滞性皮炎缓解率分别为 26.9%和 90.5%（P<.05），静脉溃疡愈合率分别为 16.7%和 87.5%（P<.05）。
不应忽视 NIVCS 的患病率。在短期随访中，对于 NIVCS 和晚期 CVD（CEAP 临床分级，≥4）患者，提出的联合治疗是一种有效的治疗策略。
