非血栓性髂静脉病变支架置入下腔静脉不同长度的临床研究

Clinical study on the different lengths of inferior vena cava stent implantation for non-thrombotic iliac vein lesions

目的评价腔内治疗非血栓性髂静脉闭塞性病变（NIVLs），支架置入下腔静脉的安全性及对髂静脉血流的中远期影响。方法回顾性分析2008年7月-2017年6月采用髂静脉支架置入治疗非血栓型髂静脉病变患者共197例，其中支架置入下腔静脉大于10mm者共141例，5-10mm者共34例，小于5mm者共22例，门诊定期随访评估双侧髂静脉再狭窄或血栓形成、支架通畅情况。计数资料采用百分比（％）表示，样本比较率采用Fisher精确检验公式分析；计量资料先进行正态性分布及方差齐性检验，再选择校正t检验。结果197例共置入髂静脉支架205枚，术后随访平均58．7个月。对侧无髂静脉血栓形成，支架发生再狭窄或血栓形成共6例，支架置入下腔静脉〈5mm者发病率（13．6％，3／22）高于〉5mm者（3．43％，6／175）（P〈0．001），其中5例再行腔内治疗后通畅。中位随访期内初始通畅率为97．0％，初始辅助通畅率为99．5％。结论腔内支架置入术治疗NIVLs具有极佳的中远期通畅率，支架置入下腔静脉是安全的，对侧髂静脉血栓形成发生率极低，而置人下腔静脉过少，则可能对支架的通畅性产生一定的影响。

Objective To assess the safety and influence of the stents extended into inferior vena cava in patients with non-thrombotic iliac vein lesions （NIVLs） on the bilateral iliac vein blood flow. Methods We retrospectively reviewed data from July 2008 to June 2017 in 197 patients with NIVLs who underwent iliac vein stenting and complete follow-up was obtained at our institution. Of these patients, stents extended into IVC more than 10 mm in 141 cases, less than 5 mm in 22 cases, and 34 cases were between 5 and 10 ram. Restenosis and thrombosis of bilateral iliac vein and patency of these stents were assessed in the follow- up. The count data were expressed by percentage （ % ） , and the sample comparison rate was analyzed by Fisher exact test formula. The measurement data were first tested for normal distribution and homogeneity of variance, and then corrected t test. Results The two hundred and five iliac vein stents were placed in 197 patients. During a mean follow-up of 58.7 months （6 to 98 months） , there were no thrombosis occurred in the contralateral iliac vein, 6 patients suffered restenosis or new thrombosis in the stents, the incidence between stenting positions less than 5 mm（ 13.6% , 3/22） and those more than 5 mm （3.43% , 6/175 ） was sighificantly different （ P 〈 0. 001 ） , and 5 of 6 patients had a good patency after endovaseular therapy. During the fllow-up, the primary and assisted-primary patency rates were 97.0% and 99.5%. Conclusions From these data, it appears that there is a very high patency rates of the stenting treatment for the NIVLs, and it is safe for the stents extended into the IVC, stenting across the iliocaval confluence can result in a small number of new contralateral thromboses. Moreover, the risk of stents restenosis or occlusion is high when stents are not extended into IVC.