髂静脉压迫综合征诊疗的研究进展

Research progress in diagnosis and treatment of iliac vein compression syndrome

目的了解髂静脉压迫综合征(iliac vein compression syndrome,IVCS)诊疗的研究进展情况,为临床诊疗寻求最佳诊疗手段。方法复习近年来有关IVCS的流行病学、病理生理、临床表现、诊断及治疗相关的文献并进行综述。结果IVCS为盆腔静脉阻塞性疾病的一种,临床上以左侧髂总静脉受到右侧髂总动脉压迫多见,也可因其他外在压力而致髂静脉流出道部分或完全闭塞;在临床上多表现为下肢静脉性疼痛、水肿、静脉曲张、静脉性溃疡、皮肤色素沉着等皮肤营养性变化;检查手段主要有彩色多普勒超声、计算机断层扫描静脉造影、磁共振静脉成像、血管内超声成像、静脉造影等;治疗方法已由原先的开放性静脉重建转为血管腔内治疗,血管腔内治疗又根据是否合并髂股静脉内血栓形成分为溶栓、取栓、经皮机械性血栓清除术、球囊扩张成形和血管内支架治疗或联合治疗。结论基于现有研究,血管内超声成像是诊断和指导血管腔内治疗的首选方式,髂静脉支架置入术是治疗IVCS的有效方法,具有良好的长期通畅性以及能显著改善症状。

Objective To investigate the research progress of diagnosis and treatment of iliac vein compression syndrome(IVCS)so as to find the optimal diagnosis and treatment method in clinic.Method Literature about etiology,pathophysiology,clinical manifestations,diagnosis and treatment of IVCS in recent years was reviewed.Results IVCS was one of the pelvic vein obstructive diseases.The compression of left common iliac vein by right common iliac artery was more common in clinic,and it could also cause partial or complete occlusion of the iliac vein due to other external pressures.Clinical manifestations mainly included venous pain,edema,varicose veins,venous ulcer,skin pigmentation,and other skin nutritional changes.The examination methods mainly included color Doppler ultrasound,computed tomography venography,magnetic resonance venography,intravascular ultrasound,and venography.The treatment method had been changed from the original open venous reconstruction to intravascular treatment.Endovascular treatment was included thrombolysis,thrombectomy,percutaneous mechanical thrombectomy,balloon angioplasty,and endovascular stent treatment or combination treatment according to whether they were combined with iliac-femoral venous thrombosis or not.Conclusion Based on the existing researches,intravascular ultrasound is the first choice to diagnose and guide the intravascular treatment,and iliac vein stenting is an effective method for the treatment of IVCS with a good long-term patency and obvious symptom improvement.