三维DSA重建用于评估髂静脉压迫病变严重程度

3D re-constructional DSA for evaluating the severity of iliac vein compression

目的:探索三维数字减影血管造影(DSA)重建用于评估髂静脉压迫病变受压严重程度的意义。方法:收集2019年6月至2021年8月台州学院附属市立医院收治的经下肢深静脉顺行造影初步筛选为髂静脉压迫病变患者72例,进一步经股静脉穿刺行二维DSA和三维DSA重建评估髂静脉压迫情况,依据二维DSA下髂静脉压迫程度将其分成三个亚组(<50%、50%~70%、>70%),比较两种造影方式对髂静脉压迫病变显示的效果,并初步探索三维DSA重建用于反映髂静脉压迫病变严重程度的指标。结果:随着髂静脉压迫狭窄程度的加重,三维DSA下反映髂静脉压迫的压迫位点,侧枝显影和髂静脉压迹等占比都上升。以髂静脉狭窄率为因变量行有序分类变量Logistic回归分析发现,对侧髂静脉显影和髂外静脉压迹对髂静脉压迫狭窄严重程度有影响,对侧髂静脉显影反映髂静脉压迫严重度是不显影的16.66倍(P=0.003),髂外静脉压迹显影反映髂静脉压迫严重度是不显影的19.13倍(P<0.001),对侧髂静脉有显影和髂外静脉有压迹的患者髂静脉压迫越严重。结论:三维DSA重建可以更好地反映髂静脉压迫病变的信息,其中侧枝显影和髂静脉压迹可以有效反映髂静脉受压严重程度,有望作为评估髂静脉压迫严重程度的新指标。

Objective:To explore the significance of three-dimensional reconstructional DSA used for evaluating the severity of iliac vein compression.Methods:Anterograde venography of lower extremity screened 72 patients as iliac vein compression,who were accepted in the author’s hospital from June 2019 to August 2021.Having further received three-dimensional reconstructional DSA and two-dimensional DSA,they were divided into three subgroups based on the degree of iliac vein compression(<50%,50%-70%and>70%).Then the effect was compared between the two kinds of angiography on the visualization of iliac vein compression.Results:The proportion of lateral branch development and iliac vein impression was both rising with the severity of iliac vein compression under three-dimensional reconstructional DSA.Logistic regression analysis of ordinal categorical variables showed the severity of iliac vein compression reflected by contralateral iliac vein development was 16.66 times higher than that without development(P=0.003)and reflected by external iliac vein development was 19.13 times higher than that without development(P<0.001).The patients’iliac vein compression was more severe when associated with contralateral iliac vein and external iliac vein development.Conclusion:Threedimensional reconstructional DSA can better reflect the information of iliac vein compression,especially lateral branch development and iliac vein impression trace can effectively assess the severity of iliac vein compression,which is worthy of further clinical study.