非血栓性髂静脉受压综合征漏诊病例分析及其腔内治疗效果评价

Analysis of misdiagnosis and efficacy of endovascular therapy in patients with nonthrombotic iliac venous compression syndrome

目的：探讨非血栓性髂静脉受压综合征（NIVCS）漏诊的原因及其腔内治疗效果。方法：回顾性分析2011年1月—2014年12月23例NIVCS漏诊患者的临床资料。结果：23例患者均为女性；平均年龄50.3（36~64）岁；均以原发性左下肢静脉曲张为首诊，行左侧大隐静脉高位结扎、主干抽剥＋点式抽剥术。患者术后平均6.2（1~13）个月出现静脉曲张复发，患肢疼痛、肿胀、疲劳；左下肢顺行静脉造影后确诊NIVCS，予左髂静脉球囊扩张＋支架植入术。患者腔内修复术后症状评分（4.2vs.6.9）、支架两端压力差（1.70cmH2Ovs.5.19cmH2O）均较术前明显降低（均P＆lt;0.05）。腔内修复术疗效评价分别为治愈7例，好转16例。随访1~24个月无复发及支架相关并发症。结论：NIVCS漏诊率高，对于女性、左下肢静脉曲张首诊的患者应提高对该病的警惕性；腔内治疗疗效确切，远期并发症少。

Objective：To investigate the causes for the misdiagnosis of nonthrombotic iliac venous compression syndrome （NIVCS） and the effcacy of endovascular therapy for this disease. Methods：The clinical data of 23 misdiagnosed cases of NIVCS from January 2011 to December 2014 were retrospectively analyzed. Results：All the 23 patients were female with an average age of 50.3 （36–64） years. All cases were initially diagnosed as primary varicose veins of letf lower extremity and underwent high ligation combined with saphenous trunk stripping plus tributary stab avulsion. The patients had recurrence of varicose vein and pain, swelling or fatigue in the affected leg 6.2 （1–13） months on average atfer surgery. hTen, they were diagnosed as NIVCS by prograde venography of the letf lower extremity and were treated with balloon dilatation and stent implantation of the left iliac vein. The symptom score （4.2 vs. 6.9） and pressure difference between the two ends of stent （1.70 cmH2O vs. 5.19 cmH2O） were signiifcantly decreased compared with the pre-treatment values （both P〈0.05）. Assessment for the effects of endovascular treatment was cure in 7 cases and improvement in 16 cases, respectively. Follow-up was conducted for one month to 24 months and no recurrence or stent-related complications occurred. Conclusion：NIVCS has high misdiagnostic rate, so vigilance should be maintained for this disease in female patients with initial symptoms of letf limb varicose veins. Endovascular therapy is effective for NIVCS with few long-term complications.