非血栓性髂静脉压迫综合症的介入治疗

Interventional Treatment of Nonthrombotic Iliac Vein Compression Syndrome

目的:探讨介入治疗髂静脉压迫综合征的疗效及安全性。方法:回顾性分析2012年11月至2016年11月本院行介入治疗的160例非血栓性髂静脉压迫综合征(IVCS)患者的临床资料。结果:160例IVCS患者,其中合并下肢静脉曲张152例,合并下肢酸胀感86例,肿胀64例,溃疡42例。行单纯球囊扩张2例,球囊扩张并植入支架158例,其中有8例患者行双侧髂静脉支架植入术,共植入支架166枚,所有植入支架均为自膨式金属裸支架。介入治疗后行二期静脉曲张切除150例。介入治疗术后下肢酸胀感消失80例(93%); 64例下肢肿胀患者术后肿胀消失60例(93. 8%); 42(100%)例合并溃疡患者介入术后(或二期手术后)均已愈合。随访1～5年(平均30个月),2例(占1. 3%)患者右髂静脉支架术后1个月出现移位,后都经体外循环心内直视下手术取出;另2例(占1. 3%)患者左髂静脉支架于术后6个月出现闭塞,后经再次介入治疗获得通畅;余156例(97. 5%)均保持通畅。2例患者出现下肢静脉曲张复发,1例术后2年溃疡再发,无深静脉血栓形成、髂静脉穿孔及其他介入治疗相关并发症发生。结论:介入治疗对左侧IVCS安全有效,右侧髂静脉放置支架要谨慎,对伴有静脉曲张者应行二期手术。

Objective: To investigate the efficacy and safety of interventional treatment for iliac vein compression syndrome. Methods: The clinical data of 160 patients of iliac vein compression syndrome( IVCS) in our hospital from November 2012 to November 2016 were analyzed retrospectively. Results: There were 160 patients of IVCS,including 152 patients of varicose veins of the lower limbs,86 patients of lower extremity acid distention,64 patients of swelling and 42 patients of ulceration. Of the 160 patients,simple balloon angioplasty was carried out in 2,both balloon angioplasty and metallic stents implantation were performed in 158. Among them,8 patients underwent bilateral iliac vein stent implantation. 166 stents were implanted,. all of which were self expanding bare metal stents. After interventional therapy,The second procedure of the great saphenous vein resection were performed on 150 patients. After interventional treatment,of lower limb soreness disappeared in 80( 93%) patients; In 64 patients of lower limb swelling,60( 93. 8%) patients feeling swelling disappeared after the stents plantation; 42 patients with ulcer were healed after interventional treatment( or the second procedure)( 100%). The patients were followed up for 1 ~ 5 years( AVR 30 months),2 patients( 1. 3%) of stent transposition in 1 month after operation,the two stents were take out with CPB for open-heart surgery; 2 patients( 1. 3%) with left iliac vein stents occlusion in 6 months after operation; the two stents were unobstructed by again interventional surgery. The rest of156 patients( 97. 5%) were unobstructed. The recurrence of varicose veins of the lower extremities was found in 2 patients and 1 cases of ulceration in 2 years after operation. There were no deep venous thrombosis,iliac vein perforation and other complications related to interventional therapy. Conclusion: Interventional treatment is safe and effective for LIVCS,The right iliac vein stent placement should be cautious. The second procedure should be performed for patients with varicose veins.