腔内治疗髂静脉压迫综合征合并急性下肢深静脉血栓形成的疗效分析

目的探讨腔内治疗髂静脉压迫综合征(iliac vein compression syndrome,IVCS)合并急性下肢深静脉血栓形成(deep vein thrombosis,DVT)的有效性和安全性。方法回顾性收集和分析甘肃省人民医院血管外科2015年6月至2018年6月期间行支架置入与球囊扩张联合AngioJet机械血栓抽吸术治疗IVCS合并急性下肢DVT的57例患者的临床资料。通过患者术前及术后患健膝下15 cm处肢体周径差的变化和术中血栓清除率评价治疗效果。此外,术后依据改良的Villaita量表评分,患者的症状、体征和下肢静脉超声及造影检查统计血栓后综合征(postthrombotic syndrome,PTS)的发生率和髂静脉的通畅率。结果本组患者的手术均顺利,技术成功率为100%;术中及术后均无肺栓塞发生;下肢深静脉血栓清除率达Ⅲ级48例(84.2%),达Ⅱ级9例(15.8%);术后患健侧膝下15 cm处肢体周径差从(5.8±1.7)cm降至(3.7±1.0)cm(P<0.001)。术后随访1年结果:髂静脉狭窄置入支架术后12个月的通畅率为86.0%(49/57);有8例(14.0%)患者发生PTS(Villalta评分>5分)。结论支架置入与球囊扩张联合AngioJet机械血栓抽吸术治疗IVCS合并急性下肢DVT形成是一种安全、有效且易于进行的血管腔内治疗方法,具有高效的血栓清除率和高的通畅率。

Endovascular intervention for iliac vein compression syndrome with acute lower extremity deep vein thrombosis

Objective To evaluate the efficacy and safety of intracavitary treatment for iliac vein compression syndrome(IVCS)with acute lower extremity deep venous thrombosis(DVT).Methods The clinical data of 57 patients with IVCS and lower extremity DVT,who undergoing with stent implantation,balloon expansion and Angiojet rheolytic thrombectomy from June 2015 to June 2018,were retrospectively analyzed.The effect of treatment was evaluated by the changes of thigh circumference difference between the affected side and the healthy side,and the thrombosis clearance rate in the operating.In addition,the incidence of post-thrombotic syndrome(PTS)and stent patency rate were analyzed after long-term follow-up based on the change of Villaita scale score and ultrasound examination of lower extremity veins.Results The success rate of surgical technique was 100%,and there was no pulmonary embolism during operating and postoperative.Lower extremity deep vein thrombosis clearance levelsⅢ48 cases(84.2%),Ⅱ9 cases(15.8%),the changes of thigh circumference difference between the affected side and the healthy side from preoperative(5.8±1.7)cm to(3.7±1.0)cm.One year follow-up after operation,the primary patency rate of stent was 86.0%and PTS occurred in 8 patients(14.0%).Conclusion Stent implantation,balloon expansion and Angiojet rheolytic thrombectomy for IVCS with acute lower extremity DVT is a safe,effective with low incidence of complications and efficient thrombus clearance.