Venous Center, Klinikum Arnsberg, Arnsberg, Germany.
Herz-Jesu-Krankenhaus Dernbach, Dernbach, Germany.
Vasa. 2021 Jan;50(1):52-58. doi: 10.1024/0301-1526/a000893. Epub 2020 Jul 22.
: Endovascular venous stenting with dedicated venous stents for the treatment of chronic venous outflow obstruction is developing as efficacious alternative to conservative therapy or open surgery. However, so far, mid- and long-term evidence on effectiveness and safety is poor. : The prospective, single-center, observational study enrolled consecutive patients with chronic non-thrombotic iliac vein lesions (NIVL) or post-thrombotic iliofemoral obstructions (PTO). From February 2016 to April 2017, patients underwent implantation of open cell, self-expandable dedicated venous stents. Short-term symptomatic improvement, patency, and complication rate were favorable. Evaluation at 2-years included improvement in the revised venous clinical severity score (rVCSS), patency, stent migration, major target limb events, clinically important pulmonary embolism, major bleeding, and all-cause mortality. : A total of 79 patients (57 ± 16 years, 44 female) were evaluated. At 2 years, rVCCS improved by 4.3 ± 2.7 (p < 0.001). Substantial clinical improvement of ≥ 2 score points was achieved in 86.4% (38 of 44) of patients. Improvement was not associated with thrombotic pathogenesis (regression coefficient [B] with PTO = 0.6 [95%CI: -1.1 to 2.3], p = 0.48). At 2 years, all ulcers (in 8 of 79 patients) were healed and none recurred. Two-year primary patency was 95.5% (95%CI: 86.5 to 98.5) with no difference between NIVL- and PTO-patients (log-rank p = 0.83). Target vessel revascularization was conducted in two PTO- and one NIVL-patients in the period of 34 days to 156 days from index procedure, resulting in a secondary patency of 100%. No stent migration, target limb deep vein thrombosis, major amputation, pulmonary embolism, or death occurred. : Venovo venous open cell self-expanding stent implantation for chronic outflow obstruction was efficacious and provided a sufficient level of safety throughout 2 years.
腔内静脉支架置入术治疗慢性静脉流出道阻塞是一种有效的治疗方法,可替代保守治疗或开放手术。然而,目前关于其有效性和安全性的中长期证据仍然不足。
这项前瞻性、单中心、观察性研究纳入了连续的慢性非血栓性髂静脉病变(NIVL)或血栓后髂股静脉阻塞(PTO)患者。从 2016 年 2 月至 2017 年 4 月,患者接受了开放式、自膨式专用静脉支架置入术。短期症状改善、通畅率和并发症发生率均较好。2 年评估包括改良静脉临床严重程度评分(rVCSS)改善、通畅率、支架移位、主要靶肢体事件、临床重要的肺栓塞、大出血和全因死亡率。
共纳入 79 例患者(57±16 岁,44 例女性)进行评估。2 年时,rVCCS 改善了 4.3±2.7(p<0.001)。44 例患者中有 86.4%(38 例)的临床症状至少改善了 2 分。改善与血栓形成机制无关(PTO 回归系数 [B]为 0.6 [95%CI:-1.1 至 2.3],p=0.48)。2 年时,79 例患者中的所有溃疡(8 例)均愈合,无一例复发。2 年原发性通畅率为 95.5%(95%CI:86.5%至 98.5%),NIVL 与 PTO 患者之间无差异(对数秩检验 p=0.83)。2 名 PTO 患者和 1 名 NIVL 患者分别在指数手术后 34 天和 156 天进行了靶血管血运重建,从而获得了 100%的二级通畅率。没有支架移位、靶肢体深静脉血栓形成、主要截肢、肺栓塞或死亡发生。
静脉诺沃开放式自膨支架置入术治疗慢性流出道阻塞是有效的,并且在 2 年内提供了足够的安全性。