左侧髂静脉压迫综合征的介入治疗

目的探讨介入治疗左侧髂静脉压迫综合征的疗效及安全性。方法本组27例,均经下肢深静脉造影或彩超确定诊断。13例发病在3周以内,表现为急性髂-股静脉血栓;14例发病超过3周,表现为慢性静脉阻塞。13例经健侧股静脉穿刺,14例经患侧腘静脉穿刺。11例溶栓前置入滤器,16例未置入滤器。均先行经导管溶栓治疗,之后7例行单纯球囊扩张术,20例球囊扩张后行内支架植入术。结果13例经健侧股静脉穿刺,导丝成功通过狭窄段8例,不能通过5例,改为造影导引下患侧腘静脉穿刺;14例直接行患侧腘静脉穿刺,在深静脉造影的导引下均穿刺成功。溶栓时间（85±16）h,尿激酶用量（300±32）万U。13例急性发作者血栓完全溶解,14例慢性者彩超报告管腔内见血流信号,提示血管部分再通。27例术后造影显示髂-股静脉血流通畅。随访时间6～26个月,平均11个月。19例静脉造影或超声显示髂-股静脉通畅,临床症状消失,8例深静脉造影或彩超提示髂-股静脉血流基本通畅,患者症状明显减轻,但仍存留肢体轻度肿胀。结论采用介入方法治疗左侧髂静脉压迫综合征,疗效确切,并发症少,可作为临床上治疗此类疾病的首选方法。

Interventional Therapy for Left Iliac Vein Compression Syndrome

Objective To evaluate the efficacy and safety of interventional therapy for left iliac vein compression syndrome （LICS）. Methods A total of 27 patients with LICS that were diagnosed by eolour Doppler or venography, were included in this study. Among the eases, the disease course was shorter than 3 weeks in 13 patients, who presented with acute iliac-femoral vein thrombosis; in the other 14 patients, the disease course was longer than 3 weeks, showing the symptoms of chronic venous thrombosis. Venous puncture was performed via the contralateral femoral vein in 13 cases, and through the ipsilateral popliteal vein in 14. Venous filter was placed in 11 cases before thrombolysis, while in the other 16 cases, no filter was used. All of the patients received catheter- directed thrombolysis, afterwards, 7 of them underwent percutaneous transluminal angioplasty, and the other 20 received angioplasty plus stent placement. Results In the 13 patients, who received venous puncture via the contralateral femoral approach, the guide wire could advance through the stenosis successfully in 8 patients but failed in 5. Ipsilateral popliteal vein puncture were then employed and succeeded in all the patients, lpsilateral popliteal puncture were performed successfully in 14 patients. In 11 patients, inferior vena cava filter was placed before the procedure. In this series, the thrombolysis time was （85 ± 16） h with a dose of （3000 ±320） thousand units urokinase. The thrombosis was dissolved completely in 13 acute patients and partial dissolution was attained in 14 patients in whom blood flow signal were detected color Doppler. After the operation, venogram showed complete patent iliac veins in all of the 27 cases. The patients were followed up for 6 to 26 months （mean, 11 months）. During the period, 19 patients obtained patent iliac-femoral vein with the symptoms disappeared; 8 patients met the standard of improvement. Conclusions lnterventional technique can be the first-line treatment for left iliac vein compression syndrome because of its favorable result and minimal invasion.