支架成形术治疗以静脉性溃疡为主要表现的非血栓性髂静脉病变效果

The curative effect of stent angioplasty for the treatment of non-thrombotic iliac vein lesions characterized mainly by venous ulcers

目的评价支架成形术治疗非血栓性髂静脉病变(NIVL)对静脉性溃疡愈合的临床意义。方法回顾性分析2014年1月至2017年12月收治的下肢静脉性溃疡并经影像学检查确诊为NIVL患者临床资料。根据治疗下肢静脉曲张的同时是否应用支架成形术处理髂静脉病变,将患者分为两组,A组(治疗组)接受大隐静脉高位结扎、静脉腔内激光治疗(EVLT),同期支架成形术处理NIVL;B组(对照组)接受单纯大隐静脉高位结扎、EVLT治疗,未处理髂静脉病变。根据随访结果比较两组患者临床效果。主要研究终点为溃疡愈合率,次要研究终点包括静脉曲张复发率、静脉疾病临床严重度评分(VCSS)。结果根据纳入和排除标准共纳入217例患者,A组114例,B组103例。两组患者术前一般资料差异无统计学意义。术后随访1~48个月,平均26个月。A组患者髂静脉支架通畅率为100%。A组、B组患者溃疡愈合率分别为91.2%(104/114)、79.6%(82/103),A组显著高于B组(P=0.02);A组患者平均VCSS评分(4.8)显著低于B组(7.5)(P=0.004);A组静脉曲张复发率(7.0%)显著低于B组(17.5%)(P=0.02)。结论支架成形术治疗以静脉性溃疡为主要表现的NIVL安全、有效,可显著促进溃疡愈合、缓解临床症状,降低静脉曲张复发率。

Objective To evaluate the clinical significance of stent angioplasty in treating nonthrombotic iliac vein lesions(NIVL)characterized mainly by venous ulcers.Methods The clinical data of 217 patients with imaging-proved NIVL associated with venous ulcers of lower extremities,who were admitted to authors’hospital during the period from January 2014 to December 2017,were retrospectively analyzed.According to whether to use stent angioplasty to treat iliac vein disease while treating varicose veins of lower extremities,the patients were divided into group A(study group,n=114)and group B(control group,n=103).Patients of group A simultaneously received high ligation of great saphenous vein,endovenous laser treatment(EVLT)and stent angioplasty for NIVL,while patients of group B received high ligation of great saphenous vein and EVLT only with no treatment of iliac vein lesions.Based on the followup results,the clinical effect was compared between the two groups.The primary endpoint of the study was ulcer-healing rate,and the secondary endpoints of the study included varicose veins recurrence rate and venous clinical symptom severity score(VCSS).Results According to the inclusion and exclusion criteria,a total of 217 patients were enrolled in this study.No statistically significant differences in preoperative general data existed between the two groups.The patients were followed up for 1-48 months,with a mean of 26 months.The patency rate of iliac vein stent in group A was 100%.The ulcer-healing rate in group A was 91.2%(104/114),which was significantly higher than 79.6%(82/103)in group B(P=0.02).The mean VCSS of group A was 4.8 points,which was obviously lower than 7.5 points of group B(P=0.004).The recurrence rate of varicose veins in group A was 7.0%,which was strikingly lower than 17.5%in group B(P=0.02).Conclusion For the treatment of NIVL characterized mainly by venous ulcers,stent angioplasty is safe and effective.This therapy can significantly promote ulcer healing,relieve clinical symptoms and reduce the recurrence rate of varicose veins.