Skaff Yara, Douane Frederic, Chastaingt Lucie, Morard Marie, Maurel Blandine, Kallassy Chady, Espinasse Benjamin, Dari Loubna, Espitia Olivier
Department of Internal and Vascular Medicine, CNRS UMR 6291, INSERM UMR 1087, l'institut du thorax Team III Vascular and Pulmonary Diseases, Nantes Université, CHU Nantes, F-44000, Nantes, France.
Department of Radiology, Nantes Université, CHU Nantes, 44000, Nantes, France.
Sci Rep. 2025 Sep 26;15(1):33123. doi: 10.1038/s41598-025-18327-w.
Chronic venous obstruction affects thousands worldwide and may lead to severe long-term complications such as post-thrombotic syndrome (PTS), marked by pain, swelling, skin changes, and venous ulcers. Endovenous stenting has become a cornerstone in restoring venous outflow, yet surveillance strategies to detect stent dysfunction early remain unstandardized. Doppler ultrasound (DUS), widely available and non-invasive, holds potential as a monitoring tool, but lacks validated markers to guide long-term follow-up. In this retrospective study of 161 patients and over 1,100 DUS assessments, we examined the predictive value of hemodynamic parameters for stent dysfunction and PTS. Stent patency was assessed using DUS or CT venography, and PTS was defined by a Villalta score ≥ 5 at last follow up. Hemodynamic parameters were compared using univariate and multivariable logistic regression models. Significant stent stenosis or occlusion (≥ 50%) was more common in younger patients (mean age 37.7 vs. 48.2 years, p = 0.003), with risk increasing by 4.4% per year decrease in age (OR = 1.044, p = 0.008). Loss of respiratory modulation was strongly associated with stent dysfunction (p < 0.001). Patients who had PTS at last follow up, had lower venous flow (297 vs. 463 mL/min, p = 0.047), reduced peak velocity (p = 0.003), and impaired respiratory modulation (p = 0.017). These findings support using DUS-derived parameters for early, non-invasive detection of stent-related complications to improve long-term patient outcomes.
慢性静脉阻塞影响着全球数以千计的人，并可能导致严重的长期并发症，如血栓形成后综合征（PTS），其特征为疼痛、肿胀、皮肤变化和静脉溃疡。腔内支架置入术已成为恢复静脉流出道的基石，但早期检测支架功能障碍的监测策略仍未标准化。多普勒超声（DUS）广泛可用且无创，具有作为监测工具的潜力，但缺乏经过验证的标志物来指导长期随访。在这项对161例患者和1100多次DUS评估的回顾性研究中，我们检查了血流动力学参数对支架功能障碍和PTS的预测价值。使用DUS或CT静脉造影评估支架通畅情况，PTS定义为最后一次随访时Villalta评分≥5分。使用单变量和多变量逻辑回归模型比较血流动力学参数。严重的支架狭窄或闭塞（≥50%）在年轻患者中更常见（平均年龄37.7岁对48.2岁，p = 0.003），年龄每降低一岁，风险增加4.4%（OR = 1.044，p = 0.008）。呼吸调制消失与支架功能障碍密切相关（p < 0.001）。最后一次随访时有PTS的患者，静脉血流较低（297对463 mL/分钟，p = 0.047），峰值速度降低（p = 0.003），呼吸调制受损（p = 0.017）。这些发现支持使用DUS衍生参数进行早期、无创检测支架相关并发症，以改善患者的长期预后。
