CDUS联合VET对髂静脉受压综合征腔内治疗后髂静脉通畅率评价研究

Diagnosis of Iliac Vein Compression Syndrome by CDUS Combined with VET and Evaluation of Iliac Vein Patency Rate after Endovascular Treatment

目的 探讨CDUS联合VET检查对髂静脉受压综合征的诊断价值及对患者腔内治疗后髂静脉通畅率的影响。方法 选择2016年1月至2018年12月在我院接受腔内介入(球囊扩张+支架置入方式)治疗的118例髂静脉受压综合征患者作为研究对象,测量所有患者手术前后髂静脉狭窄率及患肢与健肢大小腿周径差,并于患者术后一年时对所有患者均进行髂静脉CDUS联合VET及CTV检查,采用Kappa检验评价两种检查方法对髂静脉支架受压程度以及新生物所致的支架内再狭窄(ISR)诊断的一致性,并采用受试者工作特征曲线(ROC)评估CDUS联合VET检查以及CTV检查对患者管腔通畅率诊断价值。结果 118例IVCS患者经腔内手术治疗后,其髂静脉狭窄率以及患肢与健肢大小腿周径差相比术前均得到明显改善(P<0.05);术后一年随访中,CDUS联合VET与CVT两种检查方法诊断髂静脉支架受压、ISR的符合率分别为96.61%、94.92%,两者诊断髂静脉支架受压具有良好一致性(K=0.941,P<0.001;K=0.935,P<0.001)。CDUS诊断髂静脉通畅率的敏感性73.33%,特异性71.23%,约登指数0.446,AUC 0.769;VET诊断敏感性84.44%,特异性76.71%,约登指数0.612,AUC 0.842;两者联合诊断敏感性88.89%,特异性84.93%,约登指数0.738,AUC 0.889,均显著高于单一检测(P<0.05),诊断效能最佳。结论:CDUS联合VET检查与CTV在评价髂静脉支架通畅性方面具有较高一致性,且CDUS联合VET检查相较于独立检查诊断髂静脉通畅率的诊断效能提高。

Objective To investigate the diagnostic value of CDUS combined with VET on iliac vein compression syndrome and its influence on the patency rate of iliac vein after endovascular treatment. Methods 118 patients with iliac vein compression syndrome who received endovascular intervention(balloon expansion + stent implantation) in our hospital from January 2016 to December 2018 were selected as the research objects. The iliac vein stenosis rate and the circumference difference between the affected limb and the healthy limb before and after the operation in all patients were measured. All patients were examined by CDUS combined with VET and CTV of the iliac vein at one year after the operation. The Kappa test was used to evaluate the damage of the iliac vein stent The degree of pressure and the consistency of the diagnosis of in-stentrestenosis(ISR) caused by new organisms, and the use of receiver operating characteristic curve(receiver operating characteristic curve, ROC) to evaluate CDUS combined with VET examination and CTV examination for patients The diagnostic value of lumen patency. Results After intracavitary surgery in 118 patients with IVCS, the iliac vein stenosis rate and the circumference difference between the affected limb and the healthy limb were significantly improved(P<0.05);during the one-year follow-up, The coincidence rates of CDUS combined with VET and CVT in the diagnosis of iliac vein stent compression and ISR were 96.61% and 94.92%, respectively. The two methods have good consistency in diagnosing iliac vein stent compression(K=0.941, P<0.001;K) =0.935, P<0.001). The sensitivity of CDUS in diagnosing iliac vein patency is 73.33%, specificity is 71.23%, Youden index is 0.446, AUC 0.769;VET diagnostic sensitivity is 84.44%, specificity is 76.71%, Youden index is 0.612, AUC 0.842;the combined diagnosis is sensitive The sex was 88.89%, the specificity was 84.93%, the Youden index was 0.738, and the AUC was 0.889, which were significantly higher than the single test(P<0.05), and the diagnostic efficiency was the best. Conclusion CDUS combined with VET examination and CTV have high consistency in evaluating the patency of iliac vein stents, and CDUS combined with VET examination has significantly improved diagnostic efficiency compared with independent examinations, and has important application value in the diagnosis and evaluation of iliac vein patency rate.