Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, IL.
Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, IL.
J Vasc Surg Venous Lymphat Disord. 2024 Mar;12(2):101696. doi: 10.1016/j.jvsv.2023.101696. Epub 2023 Nov 15.
Pelvic venous disease (PeVD) has historically been challenging to diagnose and treat. This paper describes a comprehensive approach to the diagnosis of PeVD and reviews the role of iliac vein stent placement in treatment. Patient selection is vital for non-thrombotic iliac vein lesions (NIVLs) as only a small subset of patients with an NIVL will benefit from stent placement. There is limited, inconclusive data on optimal treatment for patients with both primary ovarian vein reflux and an NIVL. Patients with chronic post-thrombotic outflow obstruction typically have a more favorable risk/benefit ratio for intervention but require anticoagulation and close follow-up due to poorer long-term stent patency. Intravascular ultrasound is a useful tool for identifying obstructive lesions, sizing stents, and planning landing zones. More research is needed to characterize underlying pathophysiology, validate thresholds for intervention, develop reliable methods for outcomes assessment, and determine treatment response. Until this data is produced, an individualized treatment approach is warranted.
盆腔静脉疾病（PeVD）的诊断和治疗历来具有挑战性。本文描述了一种全面的诊断盆腔静脉疾病的方法，并回顾了髂静脉支架置入术在治疗中的作用。患者选择对于非血栓性髂静脉病变（NIVL）至关重要，因为只有一小部分 NIVL 患者将从支架置入中受益。对于同时存在原发性卵巢静脉反流和 NIVL 的患者，最佳治疗方法的数据有限且尚无定论。慢性血栓后流出道阻塞的患者通常更适合介入治疗，但由于长期支架通畅率较差，需要抗凝和密切随访。血管内超声是一种用于识别阻塞性病变、支架尺寸和规划着陆区的有用工具。需要进一步研究来描述潜在的病理生理学、验证干预的阈值、开发可靠的结果评估方法以及确定治疗反应。在获得这些数据之前，需要采取个体化的治疗方法。
