髂静脉支架置入术后支架闭塞的危险因素分析  

Analysis of risk factors for stent occlusion after iliac vein stenting

作　　者：吴鸿飞[1] 肖占祥[1] 曾昭凡[1] 戚悠飞[1] 张堃 WU Hongfei;XIAO Zhanxiang;ZENG Zhaofan;QI Youfei;ZHANG Kun(Department of Vascular Surgery,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China;Center for Geriatrics,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南省人民医院/海南医学院附属海南医院血管外科,海南海口570311 [2]海南省人民医院/海南医学院附属海南医院老年医学中心,海南海口570311

出　　处：《中国普通外科杂志》2022年第12期1605-1611,共7页China Journal of General Surgery

摘　　要：背景与目的:髂静脉支架置入术(IVS)能有效解除左下肢深静脉流出道梗阻、降低慢性静脉功能不全发生率,然而,IVS后支架闭塞仍然难以避免。因此,本研究探讨下肢静脉疾病患者行IVS后支架闭塞的相关因素。方法:收集自2015年3月—2020年8月由海南省人民医院血管外科收治的183行IVS患者的临床资料,采用单因素、多因素Logistic回归分析筛选患者发生支架闭塞的危险因素,以及采用受试者工作特征曲线(ROC)评估各因素的预测效能。结果:183例患者被纳入研究,其中非血栓性髂静脉压迫综合征患者(NIVCS)47例、急性下肢深静脉血栓形成患者(DVT)92例、血栓后综合征患者(PTS)44例。NIVCS患者、下肢DVT患者和PTS患者IVS术后12个月一期通畅率分别为89.4%、81.5%、54.5%。单因素分析结果显示,支架超过腹股沟韧带、支架未完全覆盖病变、支架术后侧支存在、流入道有血栓、放置多个支架、支架长度与发生支架闭塞发生明显有关(均P<0.05);多因素Logistic回归分析结果显示,支架未完全覆盖病变(95%CI=1.144~5.477,P=0.022),支架术后侧支存在(OR=2.506,95%CI=1.155~5.431,P=0.020)为支架闭塞的独立危险因素。ROC曲线结果显示,支架未完全覆盖病变预测静脉支架闭塞发生的曲线下面积(AUC)为0.623(95%CI=0.522~0.725,P=0.015),敏感度为45.2%,特异度为79.4%;支架术后有侧支存在的AUC为0.607(95%CI=0.506~0.707,P=0.036),敏感度为47.6%,特异度为73.8%。结论:支架未完全覆盖病变及支架术后有侧支存在患者IVS术后发生支架闭塞的可能性更大,应加强随访,酌情延长抗凝时间。同时,随访期间发现有支架狭窄时应尽早外科干预,降低支架闭塞发生率。Background and Aims: Iliac vein stenting(IVS) can effectively relieve the venous outflow obstruction of the left lower extremity and reduce the incidence of chronic venous insufficiency. However, stent occlusion after IVS is still inevitable. Therefore, this study was conducted to investigate the factors for stent occlusion in patients with lower extremity venous diseases after IVS.Methods: The clinical data of 183 patients undergoing IVS in the Department of Vascular Surgery of Hainan General Hospital from March 2015 to August 2020 were collected. The risk factors for stent occlusion in patients were screened by univariate and multivariate Logistic regression analysis, and the predictive efficacy of each risk factor was evaluated using the receiver operating characteristic(ROC) curve.Results: A total of 183 patients were included. Of the patients, 47 cases had non-thrombotic iliac vein compression syndrome(NIVCS), 92 cases had acute deep venous thrombosis of the lower extremity(DVT), and 44 cases had post-thrombotic syndrome(PTS). The primary patency rates of NIVCS patients, lower limb DVT patients and PTS patients at 12 months after IVS were 89.4%, 81.5%, and 54.5%, respectively. Results of univariate showed that stent across the inguinal ligament, incomplete coverage of the lesion, postoperative collaterals, inflow thrombus, multiple stent placement, and length of the stent were significantly associated with the occurrence of stent occlusion(all P<0.05);results of multivariate Logistic regression analysis showed that incomplete coverage of the lesion(OR=2.503, 95% CI=1.144-5.477, P=0.022) and presence of postoperative collaterals(OR=2.506, 95% CI=1.155-5.436, P=0.020) were independent risk factors for stent occlusion. ROC curve showed that the area under the curve(AUC) for incomplete lesion coverage was 0.623(95% CI=0.522-0.725, P=0.015), with a sensitivity of 45.2% and specificity of 79.4%. The AUC for the presence of postoperative collaterals was 0.607(95% CI=0.506-0.707, P=0.036), with a sensitivity of 47.6

关 键 词：髂静脉 支架 移植物闭塞 血管 危险因素 

分 类 号：R654.3[医药卫生—外科学]