髂静脉狭窄腔内治疗的近期疗效

Early outcomes of iliac vein stenosis after endovascular treatment

目的评价腔内技术治疗髂静脉狭窄的近期疗效。方法2006年9月—2008年1月在上海交通大学医学院附属仁济医院血管外科接受腔内治疗的髂静脉受压综合征患者21例,男9例,女12例;年龄25～80岁,平均年龄为(55±4)岁。其中左侧髂静脉病变19例,右侧2例。伴急性下肢深静脉血栓形成(DVT)17例,慢性血栓1例,无下肢DVT3例。所有患者临床均表现为肢体肿胀。17例伴急性DVT的患者先行下肢深静脉导管溶栓。本组行髂静脉经皮腔内血管成形术(PTA)治疗8例,髂静脉PTA并支架置入治疗13例。结果行PTA治疗的8例患者术后影像学评价示治愈、显效、好转各2例(6/8),无效2例(2/8);肢体肿胀治愈3例(3/8)、有效2例(2/8)、无效3例(3/8)。髂静脉PTA并支架置入治疗的13例患者术后影像学评价示治愈12例(12/13)、显效1例(1/13),肢体肿胀治愈7例(7/13)、有效3例(3/13)、无效3例(3/13)。行下肢深静脉血栓导管溶栓的17例患者术后血栓溶解Ⅲ级6例(6/17)、Ⅱ级11例(11/17)。结论PTA并支架置入是治疗髂静脉狭窄的较好方法。导管溶栓可有效地治疗急性下肢DVT,使髂静脉流入、流出道的血流通畅,是维持腔内治疗效果的关键。

Objective To evaluate the early outcomes of iliac vein occlusive disease after endovascular treatment. Methods A total of 21 patients E9 men, 12 women; median age, （55±4） years-1 with iliac vein stenosis, who were treated in our department during Setp. 2006 to Jan. 2008, were included in the present study. Nineteen patients suffered from left iliac vein stenosis and 2 patients suffered from right iliac vein stenosis. Seventeen patients presented with acute deep vein thrombosis （DVT）, 1 with chronic DVT, and 3 with no DVT. All patients had the symptom of limb swelling. Seventeen patients with acute DVT were initially treated with catheterdirected thrombolysis （CDT）. Thirteen patients received percutaneous transluminal angioplasty （PTA） and stent placement; 8 patients received PTA alone. Results In 8 patients receiving PTA alone, the rate of cure was 2/8, the rate of excellence was 2/8, the rate of improvement was 2/8, and the rate of ineffectiveness 2/8 according to the results of iliac vein angiography. As to the symptom of limb swelling, the rate of cure was 3/8, the rate of effectiveness was 2/8, and rate of ineffectiveness was 3/8. In the 13 patients who received PTA and stent placement, the rate of cure was 12/13 and rate of excellence was 1/13. As to the symptom of limb edema, the rate of cure was 7/13, the rate of effectiveness was in 3/13, and the rate of ineffectiveness was 3/13. After CDT, grade Ⅲ （complete lysis） was achieved in 6 （6/17） patients, and grade Ⅱ （50%-99% lysis） in 11 （11/17）. Conclusion Combination of PTA with stent placement appears to be a better treatment for iliac stenosis. CDT can effectively treat acute DVT and keep the patency of veins, which is the key for endovascular reconstruction of the iliac vein.