慢性髂静脉闭塞的血管腔内治疗

Endovascular treatment of chronic total occlusions of the iliac vein

目的总结慢性髂静脉闭塞血管腔内治疗的技术要点及注意事项。方法回顾性分析2006年2月至2010年8月15例慢性髂静脉闭塞的患者血管腔内治疗的临床资料。患者年龄35～81岁，平均（62±7）岁，病变均位于左下肢。患者临床CEAP分级：3级占33．3％，4级40％，5级13．3％，6级13．3％。患肢深静脉造影显示：15例患者左髂静脉完全闭塞，14例累及股总静脉；9例股浅静脉阻塞；对于股浅静脉阻塞的患者，均可见股深静脉显影。结果术中、术后无重大并发症。1例因股静脉穿刺点不合理导致腔内治疗失败，技术成功率93．3％。支架平均长度（18．4±1．2）cm。12例（80．0％）患者支架延伸至腹股沟韧带远端。术后平均随访时间（11．6±2．4）个月，术后6个月支架一期通畅率92．9％。其中lO例（66．7％）症状完全缓解；3例（20．O％）改善，1例（6．7％）症状无明显改善，1例（6．7％）症状恶化。结论运用血管腔内技术治疗慢性髂静脉闭塞，方法安全，效果确切，近期通畅率满意。

Objective To present clinical results of endovascular treatment of total iliac vein occlusions and to discuss the technique details of this treatment. Methods From Feb 2006 to Aug 2010, 15 patients with chronic total occlusive lesions of the iliac vein and adjacent vein segments underwent endovascular treatment. Average age was （62 ± 7 ） years （range 35 to 81 years）, the male/female ratio was 12： 3. Clinical score of CEAP was grade 3 in 33.3%, grade 4 in 40%, grade 5 in 13.3% , and grade 6 in 13.3%. Venography showed left iliac vein was occluded in all 15 patients, common femoral vein was occluded in 14 patients, and superior femoral vein was occluded in 9 patients, however profounder femoral vein was patent in these patients with superior femoral vein being occluded. Results No postoperative major morbidity or mortality was seen. The technique success rate was 93.3%. Treatment failure was caused in one ease for a wrong selection of the femoral vein approach site. The average length of stent was 18. 4 cm. In 12（80. 0% ） stents crossed the inguinal ligament. The average follow-up time was 11.6 ± 2. 4 months. The primary patency rates of the stents at 6 months were 92. 9%. 10 （66. 7%） patients were asympotomatic, 3（20% ）were improved, 1 （6. 7% ） was unchanged, and 1 （6.7%） was worse, compared to before intervention. Conclusions Endovscular recanalization and stent placement is a safe and effective treatment for chronic total occluded iliac veins, with good patency, significant symptom resolution, and minimal morbidity in the short term follow-up.