Qiu Jingluo, Ai Wenjia, Gu Wenduo, Lin Shaomang, Xiao Jianbin, Huang Yinqian, Qiu Tao, Xu Baohui, Zhang Zhihui
Department of Vascular Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
Department of Vascular Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China; Department of Surgery, Stanford University School of Medicine, Stanford, CA.
J Vasc Surg Venous Lymphat Disord. 2025 Mar;13(2):102002. doi: 10.1016/j.jvsv.2024.102002. Epub 2024 Nov 8.
Patients with mixed-type lower extremity deep vein thrombosis (DVT) have a higher incidence of post-thrombotic syndrome (PTS) after endovascular treatment (EVT). This study aimed to identify risk factors associated with PTS in these patients after EVT.
This retrospective study included patients diagnosed with acute mixed-type lower extremity DVT who underwent EVT between January 2020 and December 2022. Patient assessments were conducted using ultrasound examination and the Villalta scale. Baseline characteristics, management details, and follow-up findings were compared between patients who developed PTS and those who did not at 6 months after EVT. Cox regression and nomogram analyses were performed to identify risk factors associated with the development of PTS.
The study enrolled 118 patients, of which 103 completed the follow-up. Among them, 24.3% developed post-thrombotic syndrome (PTS) within 6 months. Significant differences between the PTS and non-PTS groups were found concerning residual thrombosis in the popliteal, common femoral, and femoral veins. Multivariate Cox regression analysis indicated that residual popliteal vein thrombosis (RPVT) (hazard ratio [HR], 4.93; 95% confidence interval [CI], 1.61-15.11) and preoperative iliac vein stenosis (HR, 3.21; 95% CI, 1.11-9.33) were significant risk factors for PTS. Additionally, subgroup analysis for preoperative iliac vein stenosis and sensitivity analysis confirmed that RPVT remained a risk factor for PTS (HR, 4.48; 95% CI, 1.27-15.84).
Our study demonstrated a positive association between RPVT and PTS in patients with extensive mixed-type lower extremity DVT after EVT. These findings suggest that intensive monitoring and aggressive therapeutic interventions may be required for patients with RPVT to decrease the risk of PTS.
混合型下肢深静脉血栓形成（DVT）患者在血管内治疗（EVT）后发生血栓后综合征（PTS）的发生率较高。本研究旨在确定这些患者在EVT后与PTS相关的危险因素。
这项回顾性研究纳入了2020年1月至2022年12月期间接受EVT治疗的急性混合型下肢DVT患者。使用超声检查和Villalta量表对患者进行评估。比较了在EVT后6个月出现PTS的患者和未出现PTS的患者的基线特征、治疗细节和随访结果。进行Cox回归和列线图分析以确定与PTS发生相关的危险因素。
该研究共纳入118例患者，其中103例完成了随访。其中，24.3%在6个月内发生了血栓后综合征（PTS）。在腘静脉、股总静脉和股静脉的残余血栓方面，PTS组和非PTS组之间存在显著差异。多变量Cox回归分析表明，腘静脉残余血栓形成（RPVT）（风险比[HR]，4.93；95%置信区间[CI]，1.61 - 15.11）和术前髂静脉狭窄（HR，3.21；95%CI，1.11 - 9.33）是PTS的显著危险因素。此外，术前髂静脉狭窄的亚组分析和敏感性分析证实，RPVT仍然是PTS的危险因素（HR，4.48；95%CI，1.27 - 15.84）。
我们的研究表明，在广泛混合型下肢DVT患者接受EVT后，RPVT与PTS之间存在正相关。这些发现表明，对于RPVT患者可能需要进行强化监测和积极的治疗干预，以降低PTS的风险。
