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[下腔静脉滤器相关慢性闭塞的支架置入术]

[Stent placement for filter-related chronic occlusion of the inferior vena cava].

作者信息

Zhao B X, He X, Gu J P, Lou W S, Chen L, Gong M F

机构信息

Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2019 Nov 19;99(43):3403-3407. doi: 10.3760/cma.j.issn.0376-2491.2019.43.010.

Abstract

To assess the technical success rate, stent patency, clinical efficacy and complications of stent placement for filter-related chronic occlusion of the inferior vena cava. A retrospective analysis was carried out for 12 patients with filter-related chronic occlusion of the inferior vena cava associated with severe post-thrombotic syndrome, who underwent stent placement after ineffective conservative therapy at Nanjing First Hospital from March 2016 to December 2018,9 males and 3 females, aged from 48 to 77 years, mean age 60 years, six had bilateral lower extremity symptoms and six had unilateral lower extremity symptoms.Technical success rate, stent patency, clinical efficacy and complications of stent placement were recorded. Clinical success was defined as relief of symptoms and a decrease in clinical, etiology, anatomy, and pathophysiology (CEAP) score for at least grade 1. Stent placement in the unilateral or bilateral iliocaval occlusion was successful in 11 patients. The cause of technical failure in the single patient with failed stent placement was an inability to cross the occluded left iliacvein and the patient was treated with stent placement in the right iliocaval vein.There were 7 patients with inferior vena cava and unilateral iliocaval stent placement; 5 patients with inferior vena cava and bilateral iliocaval stent placement. Acute stent thrombosis occlusion occurred in 1 case after the operation, the blood flow recanalized after catheter-directed thrombolysis and re-stenting. All patients were followed up for 6 to 24 months, with an average of (13±6) months. During the follow-up period, CTV or venography of lower limbs showed that the blood flow in the stent was unobstructed. At the last follow-up, 12 patients were evaluated as clinically effective. Three patients had transient treatment of lateral lumbar pain during operation, which alleviated by themselves.No significant abdominal pain, severe hemorrhage, symptomatic pulmonary embolism and other complications related to treatment occurred in all patients during perioperative period and follow-up. Stent placement is safe and feasible in the treatment of filter-related chronic occlusion of the inferior vena cava, which can alleviate the clinical symptoms of severe post-thrombotic syndrome.

摘要

评估下腔静脉滤器相关慢性闭塞病变支架置入术的技术成功率、支架通畅率、临床疗效及并发症。对2016年3月至2018年12月在南京医科大学第一附属医院因严重血栓后综合征行保守治疗无效后接受支架置入术的12例下腔静脉滤器相关慢性闭塞患者进行回顾性分析,其中男9例,女3例,年龄48~77岁,平均年龄60岁,双下肢症状者6例,单下肢症状者6例。记录支架置入术的技术成功率、支架通畅率、临床疗效及并发症。临床成功定义为症状缓解且临床、病因、解剖和病理生理(CEAP)评分至少降低1级。11例患者单侧或双侧髂股静脉闭塞支架置入成功。1例支架置入失败患者技术失败原因是无法通过闭塞的左髂静脉,改行右髂股静脉支架置入术。7例患者行下腔静脉及单侧髂股静脉支架置入;5例患者行下腔静脉及双侧髂股静脉支架置入。术后1例发生急性支架血栓闭塞,经导管直接溶栓及再次支架置入后血流再通。所有患者随访6~24个月,平均(13±6)个月。随访期间下肢CTV或静脉造影显示支架内血流通畅。末次随访时,12例患者评估为临床有效。3例患者术中出现短暂性腰侧疼痛,自行缓解。围手术期及随访期间所有患者均未发生明显腹痛、严重出血、有症状肺栓塞等与治疗相关的并发症。下腔静脉滤器相关慢性闭塞病变行支架置入术安全可行,可缓解严重血栓后综合征的临床症状。

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