Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241283821. doi: 10.1177/10760296241283821.
This study aimed to evaluate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) and stenting for treating acute iliofemoral deep venous thrombosis (DVT) combined with iliac vein compression syndrome (IVCS), and to identify the predictors of stent restenosis. Patients with acute proximal DVT combined with IVCS underwent PCDT and stenting from January 2017 to December 2022 were enrolled. Primary and secondary patency were assessed by duplex ultrasound (DUS). The morbidity of postthrombotic syndrome (PTS) was assessed by the Villalta score. Risk factors for stent restenosis were assessed using univariate and multivariate Cox regression models. Total of 254 patients were included. The mean follow-up time was 36.06 ± 17.66 months. The primary patency rates at 1 year, 3 years, and 5 years were 92.5%±1.7%, 85.4%±2.4%, and 82.4%±2.9%, respectively. The incidence of stent restenosis was 14.2%. Discontinuation of anticoagulants within one year [hazard ratio (HR) = 5.03; = .048] was the factor associated with acute in-stent thrombosis. Previous DVT history (HR =2.29; P = .037) and stent placement across the inguinal ligament (HR =6.70; < .001) were identified as independent risk factors significantly associated with stent restenosis. The overall PTS rate was 19.3%. PCDT with stenting is safe and effective for patients with iliofemoral DVT secondary to IVCS, leading to low rates of PTS. Previous DVT history and stents placed across the inguinal ligament may be predictors of stent restenosis. Furthermore, stent restenosis typically occurs within one year and is mainly caused by acute thrombosis due to discontinuation of anticoagulants.
本研究旨在评估药物机械性导管溶栓（PCDT）联合支架置入治疗髂股深静脉血栓形成（DVT）合并髂静脉压迫综合征（IVCS）的安全性和疗效，并确定支架再狭窄的预测因素。2017 年 1 月至 2022 年 12 月，收治了急性近端 DVT 合并 IVCS 的患者，行 PCDT 联合支架置入术。采用双功能超声（DUS）评估一级和二级通畅率。采用 Villalta 评分评估血栓后综合征（PTS）的发病率。采用单因素和多因素 Cox 回归模型评估支架再狭窄的危险因素。共纳入 254 例患者。平均随访时间为 36.06±17.66 个月。1 年、3 年和 5 年的一级通畅率分别为 92.5%±1.7%、85.4%±2.4%和 82.4%±2.9%。支架再狭窄发生率为 14.2%。一年内停止抗凝治疗[风险比（HR）=5.03；P=0.048]是导致急性支架内血栓形成的因素。既往 DVT 病史（HR=2.29；P=0.037）和支架跨腹股沟韧带放置（HR=6.70；P<0.001）是与支架再狭窄显著相关的独立危险因素。总的 PTS 发生率为 19.3%。PCDT 联合支架置入治疗 IVCS 引起的髂股 DVT 安全有效，导致 PTS 发生率低。既往 DVT 病史和支架跨腹股沟韧带放置可能是支架再狭窄的预测因素。此外，支架再狭窄通常发生在一年内，主要是由于抗凝治疗中断引起的急性血栓形成。
