介入治疗髂静脉受压综合征继发下肢深静脉血栓形成

Interventional treatment of deep venous thrombosis secondary to iliac vein compression syndrome

目的探讨髂静脉受压综合征(iliac vein compression syndrome,IVCS)继发下肢深静脉血栓形成(deep vein thrombosis,DVT)介入治疗方法及疗效。方法选取IVCS继发左下肢DVT患者96例,通过下肢静脉、髂静脉超声及下肢静脉造影明确诊断,均行导管接触性溶栓、髂静脉行髂静脉经皮腔内血管成形术,67例置入可回收下腔静脉滤器;13例单纯球囊扩张,83例球囊扩张结合支架植入治疗(髂静脉残余狭窄>50%)。结果 96例患者均成功开通病变血管,尿激酶的用量、溶栓时间分别为(297.6±49.3)万U、(4.9±1.3)d。术后1周膝上10cm、膝下10cm患健侧周径差明显小于术前(P<0.05)。术后随访6~30个月。随访期间DVT复发14例,支架内急性血栓形成1例。14例患者Villalta评分为5~14分。术后6个月单纯球囊扩张和球囊扩张结合支架植入治疗深静脉通畅率差异无统计学意义(P>0.05);术后2年单纯球囊扩张和球囊扩张结合支架植入治疗深静脉通畅率均明显低于术后6个月,球囊扩张结合支架植入治疗深静脉通畅率高于单纯球囊扩张(P<0.05)。结论髂静脉重度狭窄继发DVT无需置入下腔静脉滤器,介入治疗IVCS继发左下肢DVT近远期疗效好,安全性高,球囊扩张结合支架植入治疗方案优于单纯球囊扩张。

Objective To explore the method and curative effect of interventional treatment of iliac vein compression syndrome（IVCS）secondary lower extremity deep vein thrombosis（DVT）.Methods A total of 96 cases with iliac vein compression syndrome secondary to the left lower extremity deep vein thrombosis were selected.To clear the diagnosis through the lower limb vein,iliac venous ultrasound and lower extremity venous imaging were used,All patients were accepted catheter contact thrombolysis and percutaneous transluminal angiography.Sixtyseven cases were set into recycled inferior vena cava filter,thirteen cases were accepted pure balloon expansion,83 cases were accepted balloon expansion combined with stents implantation（iliac vein residual stenosis50%）.Results The lesions were successfully opened in 96 patients.The dosage of urokinase and the time of thrombolysis were（297.6±49.3）million units and（4.9±1.3）d,respectively.At 1week after operation,the knee circumference was 10 cm and10cm below the knee.The radial difference between the uninjured side and the uninjured side was significantly less than that before the treatment（P〈0.05）.The patients were followed up for 6-30 months.DVT recurred in 14 cases during the follow-up period.There were 1cases of acute thrombosis in stent.The Villalta score was 5-14 in 14patients.There was no significant difference in the rate of deep vein patency between balloon dilatation and balloon dilatation with stent implantation 6months after treatment（P〈0.05）.The patency rate of deep vein treated by balloon dilatation and balloon dilatation combined with stent implantation in 2 years after treatment was lower than that in 6 months after treatment,the rate of deep vein patency with balloon dilatation and stent implantation is higher than that of simple balloon dilatation（P〈0.05）.Conclusion There is no need to stent implantation to the patients with iliac vein severe stricture secondary to the lower extremity deep vein thrombosis.Interventional treatment of IVCS secondary left lower limb DVT has good short-term and long-term efficacy and high safety.balloon expansion combined with stent implantation is better than that of balloon dilation alone.