Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK.
NIHR Leicester Biomedical Research Centre, Leicester, UK.
J Endovasc Ther. 2022 Jun;29(3):478-492. doi: 10.1177/15266028211057085. Epub 2021 Nov 10.
Endovascular stenting of the deep venous system has been proposed as a method to treat patients with symptomatic iliofemoral outflow obstruction. The purpose of this systematic review and meta-analysis was to compare the effectiveness of this treatment at 1-year following the development of dedicated venous stents.
We searched MEDLINE and EMBASE for studies evaluating the effectiveness of venous stent placement. Data were extracted by disease pathogenesis: non-thrombotic iliac vein lesions (NIVL), acute thrombotic (DVT), or post-thrombotic syndrome (PTS). Main outcomes included technical success, stent patency at 1 year and symptom relief. A total of 49 studies reporting outcomes in 5154 patients (NIVL, 1431; DVT, 950; PTS, 2773) were included in the meta-analysis. Technical success rates were comparable among groups (97%-100%). There were no periprocedural deaths. Minor bleeding was reported in up to 5% of patients and major bleeding in 0.5% upon intervention. Transient back pain was noted in 55% of PTS patients following intervention. There was significant heterogeneity between studies reporting outcomes in PTS patients. Primary and cumulative patency at 1 year was: NIVL-96% and 100%; DVT-91% and 97%; PTS (stents above the ligament)-77% and 94%, and; PTS (stents across the ligament)-78% and 94%. There were insufficient data to compare patency outcomes of dedicated and nondedicated venous stents in patients with acute DVT. In NIVL and PTS patients, stent patency was comparable at 1 year. There was inconsistency in the use of validated tools for the measurement of symptoms before and after intervention. When reported, venous claudication, improved in 83% of PTS patients and 90% of NIVL patients, and ulcer healing occurred in 80% of PTS patients and 32% of NIVL patients.
The first generation of dedicated venous stents perform comparably in terms of patency and clinical outcomes to non-dedicated technologies at 1 year for the treatment of patients with NIVL and PTS. However, significant heterogeneity exists between studies and standardized criteria are urgently needed to report outcomes in patients undergoing deep venous stenting.
深静脉系统的血管内支架置入术已被提议作为治疗有症状的髂股静脉流出道阻塞患者的一种方法。本系统评价和荟萃分析的目的是比较专用静脉支架置入后 1 年时的治疗效果。
我们在 MEDLINE 和 EMBASE 中搜索了评估静脉支架置入效果的研究。根据疾病发病机制提取数据：非血栓性髂静脉病变（NIVL）、急性血栓形成（DVT）或血栓后综合征（PTS）。主要结局包括技术成功率、1 年时支架通畅率和症状缓解。共有 49 项研究报告了 5154 例患者的结局（NIVL1431 例，DVT950 例，PTS2773 例）纳入荟萃分析。各组的技术成功率相当（97%-100%）。围手术期无死亡。术中报告有 5%的患者出现轻微出血，0.5%的患者出现严重出血。介入治疗后 PTS 患者有 55%出现短暂背痛。报告 PTS 患者结局的研究之间存在显著的异质性。1 年时的原发性和累积通畅率为：NIVL-96%和 100%；DVT-91%和 97%；PTS（跨韧带支架）-77%和 94%，以及；PTS（韧带下支架）-78%和 94%。急性 DVT 患者专用和非专用静脉支架通畅率的比较数据不足。在 NIVL 和 PTS 患者中，1 年时支架通畅率相当。在干预前后测量症状时，使用的验证工具不一致。报告显示，83%的 PTS 患者和 90%的 NIVL 患者的静脉跛行得到改善，80%的 PTS 患者和 32%的 NIVL 患者的溃疡愈合。
第一代专用静脉支架在治疗 NIVL 和 PTS 患者时，在 1 年时的通畅率和临床结局方面与非专用技术相当。然而，研究之间存在显著的异质性，迫切需要标准化的标准来报告接受深静脉支架置入术的患者的结局。
