Foegh Pia, Strandberg Charlotte, Joergensen Sanne, Myschetzky Peter S, Klitfod Lotte, Just Sven, Hansen Susanne, Baekgaard Niels
Department of Vascular Surgery, 53147Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark.
Department of Diagnostic Radiology, 53146Herlev and Gentofte Hospital, University of Copenhagen, Denmark.
Acta Radiol. 2023 Feb;64(2):881-886. doi: 10.1177/02841851221090118. Epub 2022 Apr 11.
Long-term surveillance data on venous stent integrity is sparse. There is limited knowledge on whether duplex ultrasound (DUS) can detect potential stent deformities such as kinking, straightening, and fracture, which may impact long-term patency of the stented veins.
To assess venous stent integrity after at least five years of follow-up and to establish the efficacy of DUS as surveillance in patients with venous stent.
A total of 45 patients with acute iliac-femoral deep vein thrombosis (DVT) treated with catheter directed thrombolysis (CDT) and stenting >5 years before follow-up. Stents were evaluated with 3D volume low dose non-contrast computed tomography (CT) and DUS for kinking, straightening, stent fracture, and patency. Results from CT scans and DUS were compared to assess the overall agreement between the methods.
Median follow-up was 13.2 years (mean = 11.2 years; range = 5.2-15.8 years). 3D CT reconstructions showed normal stent configuration in 47 stents (89%). All intact stents were identified by DUS. In the remaining six stents, 3D CT reconstructions showed compression, tapering, kinking, and minor fracture. DUS recognized all stent complications except the minor fracture. Overall agreement between CT and DUS was 98% (kappa = 0.90). Two cases of stent occlusion were found.
The long-term physical resilience of iliac vein stents evaluated with 3D CT in patients treated with CDT for iliofemoral DVT was high. Stent deformities were mostly compression, whereas fracture was rarely seen. DUS seems to be sufficient to evaluate venous stent integrity.
关于静脉支架完整性的长期监测数据稀少。对于双功超声（DUS）能否检测出诸如扭结、变直和断裂等可能影响支架植入静脉长期通畅性的潜在支架畸形，人们了解有限。
评估至少随访五年后的静脉支架完整性，并确定DUS作为静脉支架患者监测手段的有效性。
共有45例急性髂股深静脉血栓形成（DVT）患者，在随访前5年以上接受了导管定向溶栓（CDT）和支架植入治疗。采用三维容积低剂量非增强计算机断层扫描（CT）和DUS对支架进行扭结、变直、支架断裂及通畅情况评估。将CT扫描结果与DUS结果进行比较，以评估两种方法之间的总体一致性。
中位随访时间为13.2年（平均 = 11.2年；范围 = 5.2 - 15.8年）。三维CT重建显示47个支架（89%）的支架形态正常。所有完整的支架均被DUS识别。在其余6个支架中，三维CT重建显示有受压、变细、扭结和轻微断裂。DUS识别出了除轻微断裂之外的所有支架并发症。CT与DUS之间的总体一致性为98%（kappa = 0.90）。发现2例支架闭塞。
在接受CDT治疗髂股DVT的患者中，用三维CT评估的髂静脉支架长期物理弹性较高。支架畸形主要为受压，而断裂很少见。DUS似乎足以评估静脉支架的完整性。
