腔内治疗髂静脉受压综合征伴与不伴下肢深静脉血栓效果比较  

Endovascular treatment for iliac vein compression syndrome associated with or without deep venous thrombosis: a comparison study

作　　者：汪海洋[1] 孙建明[1] 陈以宽[1] 张骞 祁小桐[1] WANG Haiyang;SUN Jianming;CHEN Yikuan;ZHANG Qian;QI Xiaotong.(Department of Abdominal Vascular Surgery, Affiliated Second Hospital, Chongqing Medical University, Chongqing 400010, China)

机构地区：[1]重庆医科大学附属第二医院腹壁血管外科,400010

出　　处：《介入放射学杂志》2018年第7期627-631,共5页Journal of Interventional Radiology

基　　金：国家自然科学基金(81470583)

摘　　要：目的评估腔内治疗髂静脉受压综合征(IVCS)伴与不伴下肢深静脉血栓形成(DVT)效果差异。方法回顾性分析2014年1月至2016年12月经下肢静脉造影确诊并经血管腔内治疗的148例IVCS患者临床资料。根据是否伴发DVT,分为非血栓性IVCS(NIVCS组,n=81)、血栓性IVCS(TIVCS组,n=67)。术后随访患肢症状改善情况及髂静脉通畅性。结果 148例患者中4例接受单纯经皮腔内血管成形术(PTA),141例接受PTA+支架植入术,3例手术失败,技术成功率为97.97%(145/148)。术后并发症发生率为9.46%(14/148),无严重并发症发生。NIVCS组63例术后3～6个月接受二期大隐静脉高位结扎+曲张静脉腔内激光闭合术均获成功。术后NIVCS组、TIVCS组患者症状均得到缓解,腔内治疗有效率分别为97.53%、94.03%(P=0.410)、髂静脉通畅率分别为96.30%、91.04%(P=0.316)。平均随访15.6(6～30)个月,TIVCS组有2例DVT复发,NIVCS组无静脉曲张复发;NIVCS组、TIVCS组患者腔内治疗有效率分别为95.59%、90.90%(P=0.465),但NIVCS组髂静脉通畅率明显高于TIVCS组(92.65%对80.00%,P=0.038)。结论腔内治疗IVCS患者效果良好,并发症少。血栓性IVCS患者腔内治疗的中远期髂静脉通畅率低于非血栓性IVCS患者。Objective To compare the effect of endovascular therapy for iliac vein compression syndrome （IVCS） with deep venous thrombosis （DVT） of lower limb with that for IVCS without DVT of lower limb. Methods The clinical data of 148 patients with lower limb venography-proved IVCS, who were admitted to authors~ hospital during the period from January 2014 to December 2016 to receive endovascular therapy, were retrospectively analyzed. According to whether IVCS was accompanied by DVT, the patients were divided into non-thrombotic IVCS group （NIVCS group, n=81 ） and thrombotic IVCS group （TIVCS group, n =67）. After endovascular treatment, all patients were followed up to assess the improvement of symptoms of affected limb and to check the patency of iliac vein. Results Of the 148 patients, pure percutaneous transluminal angioplasty （PTA） was employed in 4, PTA together with stent implantation was adopted in 141, and the operation failed in 3. The technical success rate was 97.97% （145/148）. The incidence of postoperative complications was 9.46% （14/148）, no severe complications occurred. Sixty-three patients in NIVCS group received second-stage high-level ligation of great saphenous vein plus endovascutar laser closure of varicose veins in 3-6 months after endovascular therapy, and the operation was successfully accomplished in all patients. After the treatment, the patient＇s symptoms were relieved in both groups. InNIVCS group and TIVCS group, the effective rates of endovascular therapy were 97.53% and 94.03% respectively （P=0.410）, the patency rates of iliac vein were 96.30% and 91.04% respectively （P=0.316）. The mean follow-up time was 15.6 months （6-30 months）; 2 patients in TIVCS group developed recurrence of DVT and no recurrence of varicosity occurred in NIVCS group. The effective rates of endovascular therapy in NIVCS group and TIVCS group were 95.59% and 90.90% respectively （P=0.465）, while the patency rate of iliac vein in NIVCS group was significantly higher than tha

关 键 词：腔内治疗 髂静脉受压综合征 深静脉血栓形成 

分 类 号：R528.1[医药卫生—内科学]