髂静脉受压综合征受压严重程度的影像评估及意义

The meaning of imaging characteristics in the severity of iliac vein compression syndrome

目的 评价髂静脉受压综合征(IVCS)的影像学特征(狭窄程度、腔内粘连、侧支形成)在病变严重程度评估及腔内治疗中的意义.方法 回顾性分析2013年7月至2015年12月苏州大学附属第二医院115例经股静脉插管造影同时行腔内超声检查(IVUS)确诊的IVCS患者的临床资料.CEAP分级:C2 23例、C3 30例、C4 41例、C5 10例、C6 11例,对患者行球囊扩张/支架治疗,部分患者行静脉曲张手术治疗.结果 根据静脉狭窄程度将患者分组:A组＜50％ 29例,B组50％～70％ 41例,C组≥70％ 45例.A组单纯球囊扩张(球扩)9例,一期或二期静脉曲张手术27例;B组球扩16例,球扩+支架19例,静脉曲张手术24例;C组球扩4例,球扩+支架36例,静脉曲张手术30例.随访92例,时间2～35个月,平均20.3个月.96.7％(89/92)下肢症状减轻或缓解,平均静脉临床严重程度评分(VCSS)术前7.5±1.6,术后1年1.9±0.6(P＜0.05).结论 腔内粘连的形成、侧支的出现是髂静脉受压严重程度及腔内治疗的标志,单纯的狭窄度不能准确地反映受压严重程度.IVCS腔内治疗操作简单、并发症少,但充分扩开腔内粘连是球囊扩张的重点,未充分扩张可能是导致支架后并发血栓形成的原因.

Objective To evaluate the meaning of imaging characteristics (the degree of stenosis,intraluminal spurs and collateral formation) in the severity of iliac vein compression syndrome (IVCS) andendovascular treatment.Methods Between July 2013 and December 2015,115 patients (49 men,66 women;107 in left,8 in right) with suspected IVCS were evaluated with the intent to treat iliac venous occlusion or stenosis verified by both transfemoral venography and intravascular ultrasound (IVUS).Clinical score of CEAP was 2 in 23 cases,3 in 30 cases,4 in 41 cases,5 in 10 cases,6 in 11 cases.Treatments included balloon dilation/stenting and procedures (endovenous laser ablation or stripping).Results All of the 115 limbs were successfully evaluated and treated and there was no mortality in our study.IVUS showed less than 50％ stenosis in the cross-sectional area in 29 limbs (group A),50％-70％ stenosis in 41 limbs (group B),more than 70％ stenosis in 45 limbs(group C).Balloon dilation alone was performed in 9,16,4 limbs in group A,B,C,respectively,while balloon dilation was combined with stent implantation in 19,36 limbs in group B,C,respectively.Endovenous laser ablation or stripping was performed in 27,24,30 limbs in group A,B,C,respectively.Ninety-two cases were followed up for 2-35 months (mean,20.3 months).Symptoms improved in 89 cases.The mean venous clinical severity score (VCSS) was 7.5±1.6 before endovascular treatment and 1.9±0.6 at one year after treatment(P＜0.05).Conclusions The presence of intraluminal spurs and pelvic collateral vessels are represented as indicators of the severity and treatment of IVCS.And the degree of stenosis could not accurately be represented as the severity indicator of IVCS.Endovascular intervention is a simple and effective treatment modality that can obviously reduce lower extremity symptoms,and the intraluminal spurs dilated fully is a key point in technical aspect,while not fully expansion may be the cause of thrombosis after stenting.