Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Ann Vasc Surg. 2022 Jan;78:247-256. doi: 10.1016/j.avsg.2021.06.027. Epub 2021 Aug 28.
Iliac venous stenting (IVS) for thrombotic and nonthrombotic venous disease is increasingly used as evidence of the safety, efficacy and durability of these interventions increases. Female gender has been implicated as a predictor of failure in arterial endovascular interventions. We hypothesize that female gender could be predictive of patency rates of iliac vein stenting.
Consecutive patients who underwent IVS for thrombotic or nonthrombotic venous disease at our institution from 2007 until 2019 were identified and divided into groups based on gender. Operative notes, venograms, and the electronic health record were then queried to obtain operative details, co-morbid conditions, postoperative outcomes and stent patency. Study outcome was long term patency rate. The data was analyzed using chi-square, logistic regression, and Kaplan-Meier analysis as appropriate.
A total of 200 consecutive patients (231 limbs) were identified in our retrospective analysis, with a mean age of 48.8 ± 17.3, and BMI of 31.6 ± 8.6. Of those, 119 (59.5%) patients, (131 [56.8%] limbs) were female. Comparisons between the gender groups revealed no difference in age, BMI, or preoperative comorbidities. There was no difference in type of venous disease between male (85% thrombotic, 15% nonthrombotic) and female (84% thrombotic, 16% nonthrombotic), P= 0.830. The male cohort was more likely to present with leg ulceration (17% vs. 4.6%, P = 0.002), and the female cohort was more likely to present with leg edema (98.5% vs. 93.0%, P= 0.03). The male cohort had a higher rate of caval (48% vs. 33.6%, P= 0.027) and infrainguinal stent extension. (11% vs. 6.9%, P= 0.02). Females had a higher rate of left sided stenting (80.9% vs. 66/0%, P= 0.010). There was no difference in the median stent diameter used between the cohorts. Primary patency at 5 years was significantly higher for the male cohort (94.1% vs. 74.4%, P= 0.01) On adjusted multivariable cox regression female gender was a predictor of loss of primary patency within 5 years (HR, 4.04; P= 0.007).
In this single center retrospective analysis of IVS, male patients were found to have better primary stent patency compared to female.
髂静脉支架置入术（IVS）在治疗血栓性和非血栓性静脉疾病中的应用日益增多，这也证明了这些介入治疗的安全性、疗效和持久性。女性被认为是动脉血管内介入治疗失败的预测因素。我们假设女性可能是髂静脉支架通畅率的预测因素。
回顾性分析了 2007 年至 2019 年在我院接受 IVS 治疗的血栓性或非血栓性静脉疾病的连续患者，并根据性别将其分为两组。然后查阅手术记录、静脉造影和电子病历，以获取手术细节、合并症、术后结果和支架通畅性。研究结果为长期通畅率。数据采用卡方检验、Logistic 回归和 Kaplan-Meier 分析。
在我们的回顾性分析中，共确定了 200 例连续患者（231 条肢体），平均年龄为 48.8±17.3 岁，BMI 为 31.6±8.6。其中，119 例（59.5%）患者（131 条[56.8%]肢体）为女性。两组间比较显示，年龄、BMI 和术前合并症无差异。男性（85%血栓形成，15%非血栓形成）和女性（84%血栓形成，16%非血栓形成）静脉疾病类型无差异，P=0.830。男性患者更易出现腿部溃疡（17%比 4.6%，P=0.002），而女性患者更易出现腿部水肿（98.5%比 93.0%，P=0.03）。男性患者腔静脉（48%比 33.6%，P=0.027）和下肢支架延伸（11%比 6.9%，P=0.02）的发生率较高。女性左侧支架置入率较高（80.9%比 66.0%，P=0.01）。两组使用的支架中位数无差异。男性患者 5 年主要通畅率明显高于女性（94.1%比 74.4%，P=0.01）。多变量 Cox 回归分析显示，女性是 5 年内主要通畅丧失的预测因素（HR，4.04；P=0.007）。
在这项单中心回顾性 IVS 分析中，与女性患者相比，男性患者的支架初始通畅率更高。
