Korff Ricki A, Bishay Vivian L, Fischman Aaron M, Kim Edward, Nowakowski F Scott, Patel Rahul S, Tadros Rami O, Ting Windsor, Vouyouka Ageliki G, Lookstein Robert A
Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
J Vasc Surg Venous Lymphat Disord. 2023 Mar;11(2):331-338. doi: 10.1016/j.jvsv.2022.08.001. Epub 2022 Aug 10.
Double-barrel iliocaval reconstruction is performed by deploying two stents simultaneously in a side-by-side, or "double-barrel," configuration in the inferior vena cava (IVC) with extension into the bilateral common iliac veins. The aim of this study was to examine the outcomes of double-barrel reconstruction using closed-cell dedicated venous stents for the treatment of iliocaval deep venous thrombosis and iliac vein compression syndrome.
All endovascular procedural reports comprising vascular surgery and interventional radiology operators from a single urban academic hospital between May 1, 2019, and April 30, 2021, were retrospectively searched. A cohort of 22 consecutive patients who underwent double-barrel iliocaval stenting with closed-cell dedicated venous stents for chronic or acute-on-chronic iliocaval venous disease without prior endovascular iliocaval repair was identified. Baseline characteristics, procedural data, and patient outcomes were determined via a manual review of preprocedure clinical notes, diagnostic imaging studies, procedure notes and images, and follow-up clinical notes.
The median (range) age was 59 (27-81) years, and the cohort consisted of 59.1% female. The most common presenting symptoms of venous disease were lower extremity swelling (90.9%) and pain (50.0%). CEAP clinical classification was C3 in 86.4% of patients, whereas the remainder had C4 disease. Most patients (72.7%) had post-thrombotic syndrome, 22.7% had a nonthrombotic iliac vein lesion, and one patient (4.5%) had the congenital absence of the infrarenal IVC. A total of 40.9% of patients had a pre-existing IVC filter at the time of treatment. Six of the 22 patients underwent concurrent pharmacomechanical thrombectomy during the index iliocaval reconstruction and stenting procedure. The number of stents placed ranged from 2 to 5. With a mean follow-up period of 7.1 months, ranging from 12 days to 16.7 months, the freedom from reintervention rate was 90.9%. Twenty of 22 patients achieved subjective improvement or resolution of symptoms. The major adverse event rate was 9.1%, as two patients had access site complications requiring intervention.
Double-barrel iliocaval reconstruction with closed-cell dedicated venous stents for the treatment of post-thrombotic syndrome or iliac vein compression syndrome is technically feasible and clinically effective with a low reintervention rate.
双腔髂腔静脉重建术是通过在腔静脉（IVC）中以并排或“双腔”配置同时部署两个支架，并延伸至双侧髂总静脉来进行的。本研究的目的是探讨使用闭合型专用静脉支架进行双腔重建术治疗髂腔深静脉血栓形成和髂静脉受压综合征的疗效。
回顾性检索了2019年5月1日至2021年4月30日期间一家城市学术医院的血管外科和介入放射科医生的所有血管内手术报告。确定了一组22例连续患者，他们接受了闭合型专用静脉支架双腔髂腔静脉支架置入术，用于治疗慢性或慢性血栓形成的髂腔静脉疾病，且此前未进行过血管内髂腔修复。通过人工查阅术前临床记录、诊断性影像学研究、手术记录和图像以及随访临床记录，确定基线特征、手术数据和患者预后。
中位（范围）年龄为59（27 - 81）岁，队列中女性占59.1%。静脉疾病最常见的症状是下肢肿胀（90.9%）和疼痛（50.0%）。CEAP临床分级在86.4%的患者中为C3级，其余患者为C4级疾病。大多数患者（72.7%）有血栓形成后综合征，22.7%有非血栓性髂静脉病变，1例患者（4.5%）先天性肾下IVC缺失。共有40.9%的患者在治疗时已存在IVC滤器。22例患者中有6例在初次髂腔静脉重建和支架置入术中同时进行了药物机械性血栓清除术。置入的支架数量为2至5个。平均随访期为7.1个月，范围从12天至16.7个月，再次干预的无事件发生率为90.9%。22例患者中有20例症状得到主观改善或缓解。主要不良事件发生率为9.1%，因为有2例患者出现了需要干预的穿刺部位并发症。
使用闭合型专用静脉支架进行双腔髂腔静脉重建术治疗血栓形成后综合征或髂静脉受压综合征在技术上是可行的，临床效果良好，再次干预率低。
