腔内减容技术治疗髂股静脉支架再狭窄回顾性对照研究

A retrospective controlled study on endovascular debulking technology for the treatment of iliac femoral vein stent restenosis

目的 评估腔内减容技术治疗慢性髂股静脉支架再狭窄(ISR)的安全性和早期临床疗效。方法 回顾性分析2022年7月至2023年3月期间因慢性髂股静脉ISR于上海交通大学医学院附属第九人民医院血管外科行腔内治疗的26例病人的临床与随访资料,其中9例行血管减容联合球囊扩张成形术(试验组),17例行单纯球囊扩张成形术(对照组)。比较两组病人的技术成功率、补救性支架植入率、围手术期并发症发生率和随访支架早中期狭窄发生率、慢性静脉疾病综合分类系统(CEAP)分级及血栓后综合征评分(Villalta评分)改善情况。结果试验组平均年龄(52.9±18.7)岁,共10条患肢,髂股静脉植入平均时间为(27.2±19.9)个月,临床症状复发时间为(4.1±1.4)个月;对照组平均年龄(59.8±10.1)岁,共18条患肢,髂股静脉植入平均时间为(27.5±25.8)个月,临床症状复发时间为(3.5±1.5)个月。两组技术成功率均为100%。共完成随访26例,平均随访时间(6.0±1.8)个月。两组病人术前基本资料差异无统计学意义(均P>0.05)。与对照组相比,试验组补救性支架植入比率(22.2%vs.64.7%)、术后靶支架管腔狭窄发生率(21.4%vs.28.1%)、术后3个月(24.8%vs.30.4%)及6个月的靶支架狭窄发生率(26.1%vs.32.2%)均明显降低(均P<0.05)。两组病人的CEAP临床分级和Villalta评分均较术前有所改善,但试验组的Villalta评分(7.7±1.4分vs.9.4±1.5分)改善程度大于对照组(P<0.05)。随访病人均无截肢或死亡等严重并发症发生。结论 与单纯球囊扩张成形术相比,血管减容治疗慢性髂股静脉ISR具有补救支架植入率低,术后即刻和早中期通畅率高,临床症状改善明显等优势,中远期疗效仍有待进一步随访。

Objective To evaluate the safety and early clinical efficacy of endovascular volume reduction in the treatment of chronic in-stent restenosis(ISR)of the iliofemoral vein.Methods The clinical and follow-up data of 26 patients with chronic iliofemoral vein in-stent restenosis who underwent endovascular treatment at the Department of Vascular Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine from July 2022 to March2023 were retrospectively analyzed.Seventeen patients were treated with simple balloon dilatation(control group).The technical success rate,rescue stent implantation rate,perioperative complication rate,early and mid-term follow-up stent stenosis rate,CEAP clinical classification,and Villalta score improvement were compared between the two groups.Results In the experimental group,the average age was(52.9±18.7) years,a total of 10 limbs were involved,the average time of iliofemoral vein implantation was(27.2±19.9) months,and the time of clinical symptoms recurrence was(4.1±1.4)months.In the control group,the average age was(59.8±10.1) years,a total of 18 affected limbs,the average time of iliofemoral vein implantation was(27.5±25.8) months,and the time of clinical symptoms recurrence was(3.5±1.5) months.The technical success rate of the two groups was 100%.Twenty-six patients were followed up for an average of(6.0±1.8)months.There were no significant differences in the preoperative basic data between the two groups(all P>0.05).Compared with the control group,The rate of rescue stent implantation(22.2% vs.64.7%),the rate of target stent lumen stenosis(21.4% vs.28.1%),the rate of target stent stenosis at 3 months(24.8% vs.30.4%) and 6 months(26.1% vs.32.2%)were significantly lower in the experimental group(all P<0.05).The CEAP clinical grade and Villalta score were improved in both groups,but the improvement of Villalta score in the experimental group(7.7 vs.9.4)was greater than that in the control group(P<0.05).No amputation or death occurred during the follow-up.Conclusion Compared with the pure angioplasty balloon expansion,vascular volume reduction for the treatment of chronic iliac femoral venous ISR has remedial stenting rate is low,immediate postoperative early and mid-term patency rate is high,the advantages of the clinical symptoms improved obviously,long-term effect remains to be further follow-up.