髂静脉支架突入下腔静脉对另侧髂静脉血流的长期影响  

Study on the effect of iliac vein stent entering the inferior vena cava on the contralateral venous outflow

作　　者：韦利 梁双超 冯桂林 薛清泉 夏友传 WEI Li;LIANG Shuangchao;FENG Guilin;XUE Qingquan;XIA Youchuan(Department of Vascular Surgery,The First Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241000,China)

机构地区：[1]皖南医学院第一附属医院血管外科,安徽芜湖241000

出　　处：《安徽医药》2025年第5期931-934,I0002,共5页Anhui Medical and Pharmaceutical Journal

基　　金：西藏自治区自然科学基金[XZ2023ZR-ZY48(Z)]。

摘　　要：目的在髂总静脉闭塞性病变的腔内治疗中,血管支架常需突入下腔静脉以达完全覆盖病变段。该研究通过动物实验,观察支架突入下腔静脉对对侧髂静脉血流的长期影响。方法2022年10月至2023年11月将12只比格犬采用随机数字表法分A、B两组,均于左髂静脉置入血管支架,突入下腔静脉并覆盖对侧髂静脉开口。A组分别在术后3及12个月行多普勒超声及血管造影检查,评价对右侧髂静脉通畅性的影响。B组和A组分别于术后3个月及12个月行病理检查,观察右髂静脉开口处支架内膜覆盖情况。结果术后多普勒超声及影像学检查提示:A组术后3个月多普勒超声提示对侧髂静脉开口处无狭窄性改变,术后12个月多普勒超声提示对侧髂静脉开口处有狭窄性改变。A组术后3个月及12个月右侧髂静脉均血流通畅、无血栓形成及狭窄;病理检查提示:B组术后3个月取出支架见右髂静脉开口处有部分内膜覆盖;A组术后12个月右髂静脉开口处截面积狭窄率大于60%。结论在髂静脉支架遮挡对侧髂静脉状态下,随时间延长,对侧髂静脉血流速度发生改变,且对侧髂静脉被支架增生内膜覆盖,引起对侧髂静脉开口明显狭窄,具有血栓形成的潜在风险。Objective In the endovenous treatment of occlusive lesions of the common iliac vein,a vascular stent was often required to protrude into the inferior vena cava(IVC)to achieve complete coverage of the lesioned segment.In this study,the effect of stent protrusion into the IVC on the blood flow in the other iliac vein was observed through animal studies.Methods Twelve Beagle dogs were randomly assigned into two groups A and B from October 2022 to November 2023.In the Twelve Beagle dogs,a vascular stent was placed in the left iliac vein,protruding into the IVC and covering the opening of the contralateral iliac vein.In group A,Doppler ultrasound and angiography were performed at the 3rd and 12th month after operation to evaluation the impact on the patency of the right iliac vein.Group B and Group A underwent pathological examination at 3 and 12 months postoperatively to observe the intimal coverage of the stent at the opening of the right iliac vein.Results Postoperative Doppler ultrasound and imaging findings:three months after surgery in Group A,Doppler ultrasound showed no stenosis changes at the opening of the contralateral iliac vein,however,stenosis changes at 12 months after surgery.Postoperative imaging showed that the right iliac vein was patent and free of thrombosis and stenosis at 3 months and 12 months after surgery in Group A.Pathological examination showed partial endothelial coverage of the stent at the opening of the right iliac vein at 3 months after operation in group B.The cross-sectional stenosis rate of the right iliac vein opening in group A was greater than 60%at 12 months after operation.Conclusion The iliac vein stent obscures the contralateral iliac vein,the blood flow velocity of the opposite iliac vein changes over time,the contralateral iliac vein becomes covered by the stent's hyperplastic lining,which can cause significant narrowing of the contralateral iliac vein opening with potential risk of thrombosis.

关 键 词：自膨式金属内支架 栓塞 治疗性 髂静脉 血管支架 病理学 血管内膜增生 

分 类 号：R654.3[医药卫生—外科学]