Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1577-1587.e1. doi: 10.1016/j.jvsv.2021.03.008. Epub 2021 Mar 24.
Venous injury to the inferior vena cava or iliac veins is rare but can result in high mortality rates. Traditional treatment by repair or ligation can be technically demanding. A relatively new treatment modality is the use of a covered stent to cover the venous defect. The aim of the present systematic review was to assess the techniques, results, and challenges of covered stent graft repair of traumatic injury to the inferior vena cava and iliac veins.
The PubMed (Medline) and Embase databases were systematically searched up to September 2020 by two of us (R.R.S. and D.D.) independently for studies reporting on covered stenting of the inferior vena cava or iliac veins after traumatic or iatrogenic injury. A methodologic quality assessment was performed using the modified Newcastle-Ottawa scale. Data were extracted for the following parameters: first author, year of publication, study design, number of patients, type and diameter of the stent graft, hemostatic success, complications, mortality, postoperative medication, follow-up type and duration, and venous segment patency. The main outcome was clinical success of the intervention, defined as direct hemostasis, with control of hemorrhage, hemodynamic recovery, and absence of contrast extravasation.
From the initial search, which yielded 1884 records, a total of 28 studies were identified for analysis. All reports consisted of case reports, except for one retrospective cohort study and one case series. A total of 35 patients had been treated with various covered stent grafts, predominantly thoracic or abdominal aortic endografts. In all patients, the treatment was technically successful. The 30-day mortality rate for the entire series was 2.9%. Three perioperative complications were described: one immediate stent occlusion, one partial thrombosis, and one pulmonary embolism. Additional in-stent thrombus formation was seen during follow-up in three patients, leading to one stent graft occlusion (asymptomatic). The postoperative anticoagulation strategy was highly heterogeneous. The median follow-up was 3 months (range, 0.1-84 months). However, follow-up with imaging studies was not performed in all cases.
In selected cases of injury to the inferior vena cava and iliac veins, covered stent grafts can be successful for urgent hemostasis with good short-term results. Data on long-term follow-up are very limited.
下腔静脉或髂静脉的静脉损伤很少见，但会导致高死亡率。传统的修复或结扎治疗在技术上要求较高。一种相对较新的治疗方法是使用覆膜支架覆盖静脉缺损。本系统评价的目的是评估覆膜支架治疗外伤性下腔静脉和髂静脉损伤的技术、结果和挑战。
我们中的两位（R.R.S.和 D.D.）独立地对截止到 2020 年 9 月的 PubMed（Medline）和 Embase 数据库进行了系统搜索，以查找关于外伤性或医源性损伤后下腔静脉或髂静脉覆膜支架置入的研究报告。使用改良的 Newcastle-Ottawa 量表对方法学质量进行评估。提取以下参数的数据：第一作者、发表年份、研究设计、患者数量、支架的类型和直径、止血成功率、并发症、死亡率、术后用药、随访类型和持续时间、以及静脉节段通畅性。主要结果是干预的临床成功，定义为直接止血、控制出血、血流动力学恢复和无造影剂外渗。
从最初的搜索中，共得到 1884 条记录，共有 28 项研究被纳入分析。除了一项回顾性队列研究和一项病例系列研究外，所有报告均为病例报告。总共 35 名患者接受了各种覆膜支架的治疗，主要是胸主动脉或腹主动脉内支架。所有患者的治疗均在技术上取得成功。整个系列的 30 天死亡率为 2.9%。描述了三种围手术期并发症：一个即刻支架闭塞、一个部分血栓形成和一个肺栓塞。在三名患者中，在随访期间发现了额外的支架内血栓形成，导致一个支架闭塞（无症状）。术后抗凝策略高度异质。中位随访时间为 3 个月（范围为 0.1-84 个月）。然而，并非所有病例都进行了影像学随访。
在下腔静脉和髂静脉损伤的选定病例中，覆膜支架可成功用于紧急止血，且短期效果良好。关于长期随访的数据非常有限。
