Drabkin Michael J, Bajwa Raazi, Perez-Johnston Rocio, Bryce Yolanda, Boas F Edward, Siegelbaum Robert, Durack Jeremy C, Kishore Sirish
Memorial Sloan Kettering Cancer Center, New York, NY.
Memorial Sloan Kettering Cancer Center, New York, NY.
J Vasc Surg Venous Lymphat Disord. 2021 Jan;9(1):88-94. doi: 10.1016/j.jvsv.2020.08.004. Epub 2020 Aug 10.
To identify factors associated with venous stent thrombosis in patients with cancer treated for nonthrombotic iliocaval or iliofemoral venous obstruction.
We performed a retrospective review of relevant imaging and medical records from 30 consecutive patients with cancer treated at a single center who underwent venous stent placement for nonthrombotic iliocaval or iliofemoral venous obstruction between 2008 and 2018. Follow-up imaging was used to assess stent patency. Variables examined included patient demographics, cancer type, stent characteristics, anticoagulant, and antiplatelet medications and complications of treatment.
Overall primary stent patency was 83% (25/30). The median follow-up period was 44 days (range, 3-365 days). Ten percent of patients occluded owing to in-stent thrombosis and 7% owing to tumor compression of the stent without thrombosis. Therapeutic poststent anticoagulation with enoxaparin, warfarin, or a factor Xa inhibitor was initiated in 87% of the patients. Stent thrombosis occurred in one patient in the anticoagulation group (4%) at 50 days. Stent thrombosis occurred in two patients in the nonanticoagulation group (50%), one at 9 days and the other at 91 days. Anticoagulation was found to be protective against stent thrombosis in this population (hazard ratio, 0.015; P = .011). No statistically significant associations were found among the remaining variables. One patient in the anticoagulation group experienced major bleeding (1/26 [4%]).
Iliocaval and iliofemoral stent placement for nonthrombotic malignant venous obstruction is safe with favorable primary patency rates. Therapeutic anticoagulation is associated with less stent thrombosis in patients with cancer stented for nonthrombotic iliocaval and iliofemoral venous obstruction.
确定接受非血栓性髂股静脉或髂总静脉阻塞治疗的癌症患者发生静脉支架血栓形成的相关因素。
我们对在2008年至2018年间于单一中心接受治疗的30例连续癌症患者的相关影像和病历进行了回顾性研究，这些患者因非血栓性髂股静脉或髂总静脉阻塞而接受了静脉支架置入术。采用随访影像评估支架通畅情况。所检查的变量包括患者人口统计学特征、癌症类型、支架特征、抗凝剂、抗血小板药物以及治疗并发症。
总体原发性支架通畅率为83%（25/30）。中位随访期为44天（范围3 - 365天）。10%的患者因支架内血栓形成而发生阻塞，7%的患者因肿瘤压迫支架但无血栓形成而发生阻塞。87%的患者开始使用依诺肝素、华法林或Xa因子抑制剂进行支架置入术后治疗性抗凝。抗凝组有1例患者（4%）在50天时发生支架血栓形成。非抗凝组有2例患者（50%）发生支架血栓形成，1例在9天时发生，另1例在91天时发生。在该人群中，发现抗凝可预防支架血栓形成（风险比，0.015；P = 0.011）。其余变量之间未发现有统计学意义的关联。抗凝组有1例患者发生大出血（1/26 [4%]）。
对于非血栓性恶性静脉阻塞进行髂总静脉和髂股静脉支架置入术是安全的，原发性通畅率良好。对于因非血栓性髂股静脉和髂总静脉阻塞而置入支架的癌症患者，治疗性抗凝与较少的支架血栓形成相关。
