Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China.
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China.
J Vasc Surg Venous Lymphat Disord. 2022 Jan;10(1):131-138.e3. doi: 10.1016/j.jvsv.2021.09.011. Epub 2021 Oct 8.
In clinical practice, the degree of iliac vein stenosis has often been inconsistent with the symptoms of chronic venous disease (CVD). To the best of our knowledge, no clinical studies have evaluated the hemodynamic changes associated with iliac vein stenosis. Magnetic resonance imaging (MRI) can noninvasively provide hemodynamic information. In the present study, we assessed the degree of stenosis associated with iliac venous compression syndrome and the relationships between iliac venous compression syndrome-induced, MRI-determined hemodynamic changes and lower limb symptoms.
Stenosis severity, the presence of collateral vessels, and flow rate (FR) differences between the common and external iliac veins secondary to iliac vein stenosis were measured using MRI in 69 patients with CVD. Villalta scores were used as a measure of symptom severity for all patients, and the percentage of change in the Villalta score was used as a measure of symptom improvement for the patients who had received iliac vein stents. Symptom severity for all patients, a subgroup of patients with iliac vein compression (affected limbs), and a group of patients with unilateral iliac vein compression treated with stents was correlated with stenosis, differences in the external and common iliac vein FRs (<0-mL/s group, indicating stenosis-induced decreased common iliac vein flow, and ≥0-mL/s group), and stenosis-induced collateral vessel formation.
Iliac vein stenosis severity and FR differences in all affected limbs were correlated with the Villalta scores of the affected limbs (stenosis: r = 0.38, P < .001, n = 95; FR difference: r = -0.44, P < .001). In the unilateral compression subgroup, stenosis severity, FR differences, and the presence of collateral vessels were not associated with significant changes in contralateral symptoms. In the endovascular treatment subgroup, both lower limbs exhibited significant improvement after stent implantation (affected limb symptom remission, 64.6% ± 18.2%, n = 15; contralateral limb symptom remission, 49.1% ± 29.1%, n = 11). The rate of symptom remission was greater for patients with decreased iliac vein flow in the affected limbs (<0-mL/s group: 74.6% ± 16.4%, n = 7; ≥0-mL/s group: 52.2% ± 16.6%, n = 6; P = .032).
Iliac vein stenosis, the presence of collateral vessels, and decreased FRs due to stenosis correlated significantly with lower limb symptom severity. Endovascular treatment yielded good outcomes in patients with stenosis >50%. A decreased iliac venous FR could indicate a better response to stent implantation and could be used in the diagnosis and guiding decisions to treat iliac venous compression.
在临床实践中，髂静脉狭窄的程度往往与慢性静脉疾病（CVD）的症状不一致。据我们所知，尚无临床研究评估与髂静脉狭窄相关的血流动力学变化。磁共振成像（MRI）可以无创地提供血流动力学信息。在本研究中，我们评估了髂静脉压迫综合征相关的狭窄程度，以及髂静脉压迫综合征引起的、MRI 确定的血流动力学变化与下肢症状之间的关系。
在 69 例 CVD 患者中，使用 MRI 测量髂静脉狭窄导致的狭窄严重程度、侧支血管的存在以及髂外静脉和髂总静脉之间的血流速率（FR）差异。所有患者均采用 Villalta 评分作为症状严重程度的衡量标准，采用 Villalta 评分变化百分比作为接受髂静脉支架置入术患者症状改善的衡量标准。所有患者、髂静脉压迫亚组（受累肢体）患者和单侧髂静脉压迫接受支架治疗的一组患者的症状严重程度与狭窄、髂外和髂总静脉 FR 差异（<0-mL/s 组，表明狭窄引起的髂总静脉血流减少，≥0-mL/s 组）和狭窄引起的侧支血管形成相关。
所有受累肢体的髂静脉狭窄严重程度和 FR 差异与受累肢体的 Villalta 评分相关（狭窄：r=0.38，P<0.001，n=95；FR 差异：r=-0.44，P<0.001）。在单侧压迫亚组中，狭窄严重程度、FR 差异和侧支血管的存在与对侧症状的显著变化无关。在血管内治疗亚组中，支架植入后，双侧下肢均有明显改善（受累肢体症状缓解率，64.6%±18.2%，n=15；对侧肢体症状缓解率，49.1%±29.1%，n=11）。受累肢体髂静脉血流减少的患者症状缓解率更高（<0-mL/s 组：74.6%±16.4%，n=7；≥0-mL/s 组：52.2%±16.6%，n=6；P=0.032）。
髂静脉狭窄、侧支血管的存在以及狭窄引起的 FR 降低与下肢症状严重程度显著相关。血管内治疗对>50%狭窄患者有较好的效果。髂静脉 FR 的降低可能预示着支架植入的反应更好，可用于诊断和指导髂静脉压迫的治疗决策。
