摘要
目的探讨腔内介入治疗髂静脉受压综合征的临床疗效。方法 2011年9月~2015年6月,对112例Cockett综合征行血管腔内介入治疗,其中狭窄性病变103例,髂静脉闭塞9例。CEAP分级C2级45例,C3级23例,C4级19例,C5级11例,C6级14例。经静脉造影诊断明确。经患肢股静脉入路,对髂静脉狭窄段进行球囊扩张,测量低压扩张下的球囊最小径评估狭窄程度及强度,狭窄程度>50%行支架置入。闭塞病变先经8 mm球囊扩张,合并血栓形成者行髂静脉置管溶栓,溶栓后行球囊扩张及支架置入术。术后观察肢体症状改善情况,随访彩超及下肢静脉造影。结果 9例行单纯PTA,103例置入支架,术毕造影盆腔侧支血管显影消失22例,明显减少56例,轻度减少34例。术后1个月,43例下肢肿胀患者小腿周径差从(2.56±0.88)cm降至(0.93±0.71)cm(t=20.24,P=0.000);14例活动性溃疡面积从(6.34±3.78)cm^2降至(2.13±1.88)cm^2(t=7.19,P=0.000)。随访造影86例,随访时间2~45个月,平均19.2月,术后12个月未置入支架组通畅率76.2%,置入支架组12、24、36个月通畅率分别为96.7%、88.6%、86.1%,有统计学差异(log rankχ~2=30.32,P=0.000)。支架≥16 mm组12、24个月通畅率均为95.2%,支架<16 mm组12、24个月通畅率分别为97.0%、93.3%,无统计学差异(log rankχ~2=0.39,P=0.532)。1例合并血栓者术后1个月支架再次血栓形成,1例术后8个月对侧下肢深静脉血栓形成。78例有术后12个月造影结果,6例未置入支架者发生再狭窄5例,置入支架患者通畅率为95.8%(69/72),未发现支架移位。结论腔内治疗髂静脉受压综合征临床疗效满意,支架的应用可提高髂静脉的中远期通畅率。
Objective To investigate the clinical efficacy of endovascular treatment for iliac vein compression syndrome （IVCS） in 112 cases. Methods From September 2011 to June 2015, 112 cases of IVCS （Cockett syndrome） were treated in our hospital with endovascular methods .The case numbers of different CEAP （ clinical etiological anatomical pathophysical ） classifications were C2 （45 cases）, C3 （23 cases）, C4 （19 cases）, C5 （11 cases） and C6 （14 cases）.All the cases were diagnosed by venography .The operations started from puncturing the ipsilateral veins .The stenotic degree and compressed intensity of iliac vein were evaluated by the minimum diameter with low pressure balloon .And then a stent was placed into after percutaneous transluminal angioplasty （ PTA） when residual stenosis was more than 50%.The occlusive segment was dilated by 8 mm diameter balloon firstly , and catheter directed thrombolysis treatment was applied if thrombus was detected .The PTA and stenting were performed when the thrombus was completely removed .The improvement of clinical symptoms was observed after operation and the patients were followed up by ultrasound and venograghy . Results Nine cases were given PTA only , and the other 103 cases underwent stent placement . Postoperative venography showed collateral vessels were disappeared in 22 cases, obviously decreased in 56 cases and mildly decreased in 34 cases.The average difference of swelling leg ’s circle was diminished from （2.56 ±0.88） cm pre-operation to （0.93 ±0.71） cm post-operation, while the average area of skin ulcer was diminished from （6.34 ±3.78） cm2 pre-operation to （2.13 ±1.88） cm2 post-operation, all of which were statistically significant （t =20.24 and 7.19,P=0.000）.A total of 86 cases were successfully followed up during a period from 2 months to 45 months （average, 19.2 months）.The patency rate of treated iliac vein 12 months after operation was 76.2%in the PTA group, and in the PTA with stenting group was 96.7%, 88.6%, and 86.1%, respectively, at 12, 24, and 36 months after operation, in which a statistical significance was detected （log-rank χ2 =30.32, P=0.000）.The patency rate in diameter ≥16 mm group was 95.2%and 95.2%, respectively, at 12 and 24 months after operation, while in diameter ＆lt;16 mm group was 97.0%and 93.3%, respectively, in which no statistical significance was detected （log-rankχ2 =0.39, P=0.532）.Thrombotic complication was found in 2 cases during the follow-up period , including 1 case of iliac vein thrombosis at 1 month and 1 case of thrombus in contralateral leg 8 months later .According to the results of venography in 78 cases at 12 months after operation , restenosis was found in 5 out of 6 cases in the PTA group, and the patency rate in the stent placement group was 95.8%（69/72）.No stent migration was found . Conclusion Comfortable clinical results were obtained after endovascular therapy for iliac vein compression syndrome , and the application of stenting could increase the middle and long term patency rate of treated vessels .
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第10期879-883,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
髂静脉受压综合征
血管成形术
溶栓
支架
诊断标准
Iliac vein compression syndrome
Percutaneous transluminal angioplasty
Thrombolysis
Stents
Diagnostic criteria
