一站式腔内治疗急性深静脉血栓形成合并髂静脉压迫综合征的临床价值

Clinical value of one-stop endovascular treatment for acute deep vein thrombosis with iliac vein compression syndrome

目的探索一站式腔内治疗急性深静脉血栓形成(DVT)合并髂静脉压迫综合征(IVCS)的临床价值。方法回顾性分析2018年1月至2022年10月北京安贞医院血管外科治疗左侧DVT合并IVCS的35例患者的临床资料。采取一站式腔内治疗的方法, 观察术后疗效及并发症情况。采用t检验比较手术前后的患肢周径和相关实验室指标。结果 35例患者均成功完成一站式腔内治疗, 手术成功率100%。患肢治疗后静脉通畅度评分[(1.6±0.7)分比(10.9±2.8)分, t=9.400, P<0.01]、患肢膝上及膝下周径差[(1.8±0.5)cm 比(6.3±0.8)cm, t=34.908, P<0.01;(1.6±0.2)cm 比(4.6±0.7)cm, t=11.188, P<0.01]均较治疗前减小, 差异均有统计学意义。患者治疗后血红蛋白、D-二聚体水平较治疗前降低, 差异有统计学意义[(9.9±1.0)g/L 比(12.0±0.7)g/L, t=4.795, P<0.01;(1 257.3±276.7)ng/ml 比(4 652.3±1 850.7)ng/ml, t=6.073, P<0.01];肌酐水平与治疗前比较, 差异无统计学意义(P=0.836)。35例患者均获得随访, 随访时间为(31.7±16.4)个月(范围:6~63个月)。随访期内, 3例患者出现行走后轻度疼痛, 2例出现久站后沉重感(Villalta评分均<5分), 且彩超结果提示患肢静脉通畅, 无血栓形成后综合征发生。结论一站式腔内治疗急性DVT合并IVCS可以安全、有效地清除血栓、恢复管腔以及预防静脉血栓后综合征。

Objective To explore the clinical value of one-stop endovascular treatment for acute deep vein thrombosis(DVT)combined with iliac vein compression syndrome(IVCS).Methods The clinical data of 35 patients treated for left DVT combined with IVCS at the Department of Vascular Surgery,Beijing Anzhen Hospital,from January 2018 to Dctober 2022 were retrospectively analyzed.One-stop endovascular treatment was conducted and postoperative efficacy and complications were observed.T-test was used to compare the circumference of affected limbs and related laboratory indicators before and after surgery.Results All 35 patients completed one-stop endovascular treatment with a 100%of surgical success rate.After treatment,the venous patency score[1.6±0.7 vs 10.9±2.8,t=9.400,P<0.01],circumference difference in the upper and lower knees of affected limbs[(1.8±0.5)cm vs(6.3±0.8)cm,t=34.908,P<0.01;(1.6±0.2)cm vs(4.6±0.7)cm,t=11.188,P<0.01],and the patient's hemoglobin[(9.9±1.0)g/L vs(12.0±0.7)g/L,t=4.795,P<0.01]and D-dimer[(1257.3±276.7)ng/ml vs(4652.3±1850.7)ng/ml,t=6.073,P<0.01]were lower than before treatment.The differences were statistically significant.The creatinine level did not change significantly compared with before treatment(P=0.836).Thirty-five patients completed the(31.7±16.4)month(range:6-63 months)follow-up,3 patients experienced mild pain after walking,and 2 patients experienced heaviness after a long standing(all Villalta scores<5).The color ultrasound results suggested that the veins of the affected limb were unobstructed,and no post-thrombotic syndrome(PTS)occurred in the follow-up patients.Conclusions One-stop endovascular treatment for acute DVT with IVCS is safe and effective in removing thrombus,restoring the lumen,and preventing PTS.