对侧髂静脉血栓形成与髂静脉病变的关系研究

Study on the relationship between iliac vein lesions and contralateral iliac vein thrombosis

目的探讨对侧髂静脉血栓形成与髂静脉病变的关系。方法收集2017年1月至2022年12月于上海交通大学医学院附属第九人民医院进行髂静脉支架植入术治疗的586例髂静脉病变患者的临床资料。观察髂静脉支架植入术后对侧髂静脉血栓形成的发生情况,比较血栓性髂静脉病变[急性深静脉血栓形成(DVT)和血栓形成后综合征(PTS)]患者与非血栓性髂静脉病变(NIVL,又称MTS)患者对侧髂静脉血栓形成的发生率。结果髂静脉支架植入术后对侧髂静脉血栓形成的总发生率为2.73%(16/586),均为右侧髂静脉血栓形成,其中,DVT患者6例,PTS患者8例,MTS患者2例。血栓性髂静脉病变(急性DVT和PTS)患者对侧髂静脉血栓形成的发生率为4.91%(14/285),高于MTS患者的0.66%(2/301),差异有统计学意义(P=0.002)。MTS和PTS患者发生对侧髂静脉血栓形成的时间较晚,DVT患者发生对侧髂静脉血栓形成的时间较早。16例右侧髂静脉血栓形成的患者中,15例患者的左侧髂静脉支架伸入下腔静脉,并且支架近心端与下腔静脉右侧壁相接触;支架种类与对侧髂静脉血栓形成无相关性。结论髂静脉支架植入术后对侧髂静脉血栓形成多发生于血栓性髂静脉病变患者。支架植入术中尽量避免支架近心端与下腔静脉对侧壁相接触。若DVT患者的髂静脉支架与下腔静脉对侧壁相接触,术后早期需特别重视规范抗凝治疗和规律随访。

Objective To investigate the relationship between iliac vein lesions and contralateral iliac vein thrombosis.Method The clinical data of 586 patients with iliac vein lesions who underwent iliac vein stent implantation at the Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine from January 2017 to December 2022 were collected.The occurrence of contralateral iliac vein thrombosis after iliac vein stent implantation was observed.The incidence rate of contralateral iliac vein thrombosis in patients with thrombotic iliac vein lesions[acute deep venous thrombosis(DVT)and post-thrombotic syndrome(PTS)]with those in patients with non-thrombotic iliac vein lesion(NIVL)[also known as May-Thurner syndrome(MTS)]were also compared.Result The overall incidence rate of contralateral iliac vein thrombosis after iliac vein stent implantation was 2.73%(16/586),all of which were right iliac vein thrombosis.Among them,there were 6 DVT patients,8 PTS patients,and 2 MTS patients.The incidence rate of contralateral iliac vein thrombosis in patients with thrombotic iliac vein disease(acute DVT and PTS)was 4.91%(14/285),which was higher than 0.66%(2/301)in patients with MTS,and the difference was statistically significant(P=0.002).The onset time of contralateral iliac vein thrombosis was later in patients with MTS and PTS and earlier in DVT patients.Among the 16 patients with right iliac vein thrombosis,15 patients had their left iliac vein stent extended into the inferior vena cava,and the proximal end of the stent was in contact with the right wall of the inferior vena cava.There is no correlation between the type of stent and the occurrence of contralateral iliac vein thrombosis.Conclusion Contralateral iliac vein thrombosis after iliac vein stent implantation mostly occurs in patients with thrombotic iliac vein lesions.It is necessary to avoid contact between the proximal end of the stent and the contralateral wall of the inferior vena cava during stent implantation.If the iliac vein stent in DVT patients is in contact with the contralateral wall of the inferior vena cava,special attention should be paid to standardizing anticoagulation therapy and regular follow-up in the early postoperative period.