Prevalence of hypercoagulable states in stented thrombotic iliac vein compression syndrome with comparison of re-intervention and anticoagulation regimens

BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease.Iliac stent patency is multifactorial,and current management is based on best clinical practices,varying by institution.AIM To evaluate how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression syndromes.METHODS A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent common iliac vein(CIV)stenting between December 2013 and December 2019 at a large academic center.Search criteria included CIV stenting and iliac vein compression.Nonthrombotic lesions and iliocaval thrombosis and/or occlusions were excluded.A total of 65 patients were selected for final analysis.Demographic information,procedural data points,and post-procedural management and outcomes were collected.Statistical analyses included Fisher's exact and Chi-square tests to compare discrete variables and the Wilcoxon rank-sum test to compare continuous variables between thrombophilia positive and negative patients.RESULTS 65 patients underwent successful balloon angioplasty and CIV stenting.Of these patients,33(50.8%)underwent thrombophilia testing,with 16(48.5%)testing positive.Stent patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo(92.3%vs 81.3%,P=0.6),6 mo(83.3%vs 80%,P>0.9),or 12 mo(77.8%vs 76.9%,P=0.8).Immediately after stent placement,thrombophilia patients were more likely to be placed on dual therapy(aspirin and anticoagulation)or triple therapy(aspirin,clopidogrel,and anticoagulation)(50%vs 41.2%,P>0.9),and remain on dual therapy at 6 mo(25%vs 12.5%,P=0.5)and 12 mo(25%vs 6.7%,P=0.6).There was no significant difference in re-intervention rates(25%vs 35.3%,P=0.7)or number of reinterventions(average 2.3 vs 1.3 per patient,P=0.4)between thrombophilia positive and negative patients.CONCLUSION Half of patients with stented thrombotic iliac vein compression syndrome and thrombophilia testing were positive.The presence of thrombophilia did not significantly impact stent patency or re-intervention rates.

Endovascular stent treatment of the iliac vein stenosis caused by a pelvic lymphocele secondary to gynecologic malignancy

Over the past two years,6 patients had iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy.Patients had symptomatic lymphoceles induced lower limb edema.Poor treatment of symptomatic lymphoceles,compression symptoms persist,all patients were performed endovascular stent therapy,clinical symptoms of lower limb were completely relieved.Iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy,endovascular stent placement is a nonsurgical alternative for the reestablishment of venous flow and sustained relief of symptoms.

Double Pulmonary Embolism and Left Common Iliac Vein Thrombosis after in vitro fertilization and embryo transfer： a Case Report

This article discusses the mechanism, diagnosis, and treatment of a case of double pulmonary embolism and left common iliac vein thrombosis following in vitro fertilization （IVF） and embryo transfer （ET） to arouse vigilance for unexpected thrombosis after ovarian hyperstimulation and to serve as a clinical reference of this condition. This paper reports the case of a woman with double pulmonary embolism and left common iliac vein thrombosis after IVF-ET and the successful management of this condition. The woman had primary infertility, and underwent IVF-ET with 14 ooeytes recovered and two embryos transferred. The patient suffered breathing difficulty 17 days after the ET, and was hospitalized 6 days later as her condition had exacerbated. Computed tomographic （CT） angiography of pulmonary arteries showed double pulmonary embolism, left common iliae vein thrombosis, abnormal density shadow in uterine appendages, and ascites. A healthy baby boy and girl were safely delivered by Caesarean section after successful treatment. Thrombosis after IVF-ET is an uncommon but life-threatening complication and concurrent pulmonary embolism is even rarer. It is suggested that careful thrombosis risk assessment be taken before therapy and particular attention be paid to patients with special body constitutions to develop thrombosis. Whenever patients experience breathing difficulty after IVF-ET, it is strongly advised to examine the possibility of pulmonary embolism. The main treatments for thrombosis are anticoagulant therapy by low-molecular-weight heparin and thrombolysis by urokinase.

Strategies for the diagnosis and treatment of the iliac vein compression syndrome

Aim:To evaluate the diagnosis and treatment strategies for the iliac vein compression syndrome(IVCS) and the factors that affect the treatment outcome.Methods:In total,69 patients with IVCS were enrolled in the study.The patients underwent computed tomography(CT) venography before treatment.CT observations included assessment of the iliac venous channel sagittal diameter(IVCD) before the lower lumbar vertebra,causes of oppression,thrombus density,and embolization range.The patients with IVCS were divided into the simple IVCS(s IVCS,n=22),lumbar degeneration-related type IVCS(d IVCS,n=33),and IVCS of other causes(o IVCS,n=14) including lumbar fracture,hematoma of infection,and abscess wraping around and compressing the iliac vein,groups.The treatment methods included target venous catheter-directed thrombolysis(CDT),a mechanical breaking and sucking treatment for the thrombi,followed by balloon dilatation and iliac vein stent implantation.The factors that may possibly affect the treatment outcomes included IVCS type,duration of disease,thrombus hardness,embolization length,and treatment regimen.Logistic regression was used to analyze the factors that affected the therapeutic efficacy.Results:At the first stage,CDT was only effective in 15 cases(5 d IVCSs and 10 o IVCSs) and was ineffective in the remaining 54 cases,which required further mechanical breaking and sucking of the thrombi and intravenous balloon dilatation.In the second stage,combination of thrombi breaking and suction and balloon dilatation was preliminarily effective in 26 cases(6 s IVCSs,16 d IVCSs and 4 o IVCSs),but during follow-up from 1 to 6 months,treatment was considered futile for 9 recurrent cases(3 s IVCSs and 6 d IVCSs).So,28 cases of preliminary ineffective treatment and 9 relapse in the second stage were arranged to the third stage of treatment by iliac vein stent implantation.All 37 cases were treated effectively and achieved a satisfactory iliac vein patency,and were followed-up for 24 months without recurrence.Logistic regression analysis showed that IVCS type(β=4.14;Wald test,P < 0.01),duration of illness(β=-5.33;Wald test,P=0.02),thrombus density(β=-6.46;Wald test,P=0.01),embolization length(β=2.74;Wald test,P=0.03),and treatment regimens(β=11.92;Wald test,P=0.01) all had a significant effect on the treatment outcomes.Conclusion:The selection of a suitable intervention treatment regimen for different types of IVCS may aid in improving the curative effect.

Spontaneous Rupture of the Left External Iliac Vein: Case Report

Spontaneous rupture of the iliac vein is rare clinical emergency. Sudden onset, hypertension, and abdominal distention with a nonpulsatile mass in the iliac fossa are the chief symptoms. We reported another case of spontaneous rupture of the left external iliac vein diagnosed intra-operatively and successfully treated with direct suturing. And related literatures were reviewed. Possible etiology and optimal treatment were discussed.

Towards a Classification of Left Common Iliac Vein Compression Based on Triplanar Phlebography

Introduction: There is currently no consistent classification of the extent of left common iliac vein compression syndromes such that clinicians working in the area have a common terminology. Hypothesis: To create a classification of left common iliac vein compression based on the end point of triplanar pelvic phlebogrpahy. Methods: Based on 61 consecutive patients found to have left common iliac vein compression on triplanar phlebography in the course of treatment of venous disease, clinical presentation and symptomatology were retrospectively used to create a classification of left common iliac vein compression. Treatment of left common iliac vein compression was also retrospectively correlated with staging. Results: The following classification was arrived at: Stage 0, no compression and no intraluminal fibrous bands;Stage 1, evidence of compression by surrounding anatomical structures with or without the presence of fibrous bands;Stage 2: evidence of compression with or without fibrous bands as evidenced by cross-pelvic collaterals;Stage 3: compression of the left common iliac vein. Fibrous bands replaced by localised occlusion, with collateralisation and no involvement of adjacent venous segments;Stage 4a: as for Stage 3 but with the addition of thrombotic involvement of adjacent venous segments;Stage 4b: as for Stage 4a but with involvement of distal venous segments, femoral and popliteal. Stages 3, 4a or 4b correlated well with clinical presentations of DVT, PE, venous ulceration, vulval or cross-pelvic collaterals, ipsilateral limb swelling and claudication. The presence of varicose veins or recurrent varicose veins was a common finding amongst all groups. Conclusion: Acceptance of this classification system would provide a common terminology to allow more transparent assessment of modalities of treatment for this condition.

Endovascular treatment of iliac vein compression syndrome

Background Iliac vein compression syndrome （IVCS）, the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS. Methods Between January 1997 and September 2008, 296 patients received interventional therapy in the left common iliac vein. In the second stage, 170 cases underwent saphenous vein high ligation and stripping. Two hundred and thirty-one cases were followed up over a period of 6 to 120 months （average 46 months） and evaluated for symptom improvement with color ultrasound and ascending venography. Results The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases, of whom 272 received stent implantation therapy. Most of the patients achieved satisfactory results on discharge. During the follow-up period, varicose veins were alleviated in 98.7% of the patients, and leg swelling disappeared or was obviously relieved in 84% of cases. About 85% of leg ulcers completely healed. The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography. Conclusions Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.

A systematic review of DVT and stent restenosis after stent implantation for iliac vein compression syndrome

Iliac vein compression syndrome(IVCS)is a common venous disease caused by joint compression of the right common iliac artery and the lumbosacral vertebrae.The compression of iliac vein not only causes venous hypertension in the lower extremities,but also induces venous valve dysfunction and superficial varicose veins in lower extremities.Moreover,the compression of iliac vein is an important potential factor for iliofemoral vein thrombosis.Currently,open surgery and stent implantation are the main treatment for IVCS.Due to the advantages of minimally invasive and postoperative patency,stent implantation for IVCS has gradually become the standard treatment.However,when the stent is implanted into the iliac vein to treat IVCS,the complications,such as restenosis,deep vein thrombosis(DVT)appear,which affect the patency of stent and hamper the patient recovery.Up to now,the mechanism how the stent implantation induces the restenosis and DVT is still unclear.In this review,we summarized the clinical symptoms,treatment methods of IVCS and the complications after stent implantation,and analyzed the mechanism of stent restenosis and DVT,and finally discuss the iliac vein stent design specifically for treating IVCS.

Incidence and Risk Factors of Deep Venous Thrombosis in Asymptomatic Iliac Vein Compression： A Prospective Cohort Study

Background： Deep vein thrombosis （DVT） may be associated with iliac vein compression. Up to now, the majority of data has come from a retrospective study about the correlation between DVT and iliac vein compression. This prospective study was to detemline the incidence of DVT in individuals with iliac vein compression and identify risk factors predictive of DVT. Methods： A total of 500 volunteers without symptoms of venous diseases of lower extremities and overt risk factors of deep venous thrombosis between October 2011 and September 2012 in Shijitan Hospital were enrolled in this cohort study. All the participants underwent contrast-enhanced abdominal computed tomography （CT） to evaluate lilac vein compression. Baseline demographic information and degree of iliac vein compression were collected. They were categorized into ≥50% or 〈50% iliac vein compression group. Ultrasound examination was pertbrmed to screen DVT at the time of CT examination and 3, 6, 9, and 12 months alter the examination. Primary event was DVT of ipsilateral lower extremity. Correlation between DVT and iliac vein compression was estimated by multivariate Logistic regression alter adjusting for age, gender, malignancy, surgery/immobilization, chemotherapy/hormonal therapy, and pregnancy. Results： In 500 volunteers, 8.8% （44） had 〉50% iliac vein compression and 91.2% （456） had 〈50% lilac vein compression, lpsilateral DVT occurred in six volunteers including two in iliofemoral vein, two in popliteal vein, and two in calf vein within 1 year. Univariate analysis showed that the incidence of DVT was 6.8% in 〉_50% compression group, significantly higher than that in 〈50% compression group （0.7%） （Х^2= - 12.84, P 0.01）. Patients with malignancy had significantly higher incidence of DVT than those without malignancy （Х^2 = 69.60, P〈 0.01 ）. Multivariate Logistic regression indicated that iliac vein compression and malignancy were independent risk factors of DVT. Alter adjustment for malignancy, patients with ≥50% iliac vein compression had 10-fold increased risk of developing DVT （adjusted relative risk [RR] = 10.162, 95% confidence interval [CI]： 1.149-89.865, P = 0.037）. In subgroup analysis, patients with malignancy and -〉50% iliac vein compression had 12-fold increased the risk of DVT than those without malignance and ≥50% compression （RR = 12.389, 95% CI： 2.327-65.957, P-0.003）. Conclusions： lliac vein compression is common, but the incidence of DVT is low. Only individuals with ≥50% lilac vein compression or compression combined with other risk factors might have significantly increased the risk of DVT. Further study is recommended to improve prevention strategies for DVT in significant iliae vein compression.

Endovascular treatment of acute proximal deep venous thrombosis secondary to iliac vein compression syndrome： a novel technique for thrombus removal

Iliac vein compression syndrome （IVCS）,also known as May-Thurner syndrome or Cockett syndrome,is caused by compression of the left common iliac vein between the right common iliac artery and the vertebrae.A recent imaging study have demonstrated that at least a 25%compression of the left iliac vein at the arterial crossover point may be present in 66% of the asymptomatic patient population.1 With the development of interventional technique,endovascular management as a less invasive means is becoming the first-line treatment,which can not only treat the thrombosis but also correct the venous anatomic abnormalities.2 In this study,we described a novel technique combining percutaneous aspiration thrombectomy （PAT） with Fogarty catheter thrombectomy （FCT） as the thrombus removal therapy without femoral venotomy in patients with acute deep vein thrombosis （DVT） due to IVCS and evaluated its technical feasibility and short-term outcomes.

The impact of standardized methods of hepatic vein reconstruction with an external iliac vein graft

Background:Liver tumors that invade the hepatic vein are surgically challenging,especially in patients with liver dysfunction.Preservation of as much of the parenchyma as possible is important;thus,when feasible,we perform hepatectomy with hepatic vein reconstruction(HVR)using an external iliac vein(EIV)graft.We conducted a retrospective study to investigate the benefit of HVR and to evaluate our procedure.Methods:The study included patients treated by hepatectomy with HVR using EIV grafts and vascular clips.We reviewed the surgical outcomes,including total operation and HVR times,postoperative complications,and postoperative liver function.Results:The surgeries included right HVR(n=13),left HVR(n=3),and middle HVR(n=1).The total operation time was 277±72 minutes(155-400 minutes),and the HVR time was 27±5 minutes(19-40 minutes).Graft patency was confirmed in 14(82%)of the patients.One patient who underwent HVR with running sutures required emergency surgery due to graft thrombosis.Clavien-Dindo>grade IIIa postoperative complications occurred in 4(23.5%)patients,but there were no treatment-related deaths.Conclusions:In conclusion,our hepatic resections with HVR using the same techniques and graft materials showed acceptable surgical outcomes.From our experience,we believe that preparatory hepatic resection with HVR is an effective treatment,especially for patients with decreased liver function or with a small residual liver parenchyma.

Application of 3D Digital Reconstruction and Printing to the Diagnosis and Treatment of Iliac Vein Compression

The objective of this research was to explore the feasibility and clinical application of a new diagnostic imaging method for the diagnosis and treatment of iliac vein compression(IVC)based on three-dimensional(3D)digital reconstruction and printing.This study included patients with chronic venous disease(CVD)who were admitted to the Department of Vascular Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,from January to March,2019,and underwent computed tomography venography(CTV)to detect IVC.CTV findings were used to reconstruct 3D-printed models of blood vessels.A total of 17 patients(5 men and 12 women)with IVC,who were primarily diagnosed with CTV,were included in this study.In addition,24 significant venous compression sites were found in 17 patients,of which 7 patients had only one compression site(41.2%),nine patients had two compression sites(52.9%),and one patient had three compression sites(5.9%).3D digital reconstruction and printing is a convenient,noninvasive,and accurate diagnostic imaging method that provides a clear and accurate evaluation of veins and arteries,as well as the anatomical positional relationship for the diagnosis and treatment of IVC.

经同侧大隐静脉入路髂静脉成型及支架植入术在日间治疗模式中的应用

目的:探讨髂静脉狭窄患者经同侧大隐静脉入路髂静脉成型及支架植入术在日间治疗模式中应用的可行性和近期疗效。方法:回顾性分析2017年2月至2022年3月经同侧大隐静脉入路实施髂静脉成型及支架植入术日间模式治疗的病例,共21例,男6例,女15例,年龄37~79岁[(62.5±10.2)岁]。髂静脉狭窄中单纯累及髂总静脉16例,单纯累及髂外静脉2例,同时累及髂总及髂外静脉3例,均通过同侧大隐静脉入路行髂静脉成型及髂静脉支架植入术,同时存在大隐静脉瓣膜功能不全的单纯髂静脉狭窄患者同期行大隐静脉射频闭合及曲张静脉硬化治疗术。术后规律直接口服抗凝药治疗及压力治疗,所有患者住院时间均于小于24 h。结果:所有21例患者手术均成功(手术成功率100%),术中无并发症,术后即刻并发症中穿刺点出血1例,加压包扎纱布被完全浸湿,经再次压迫止血5 min后渗血停止,所有患者住院时间均于小于24 h。随访结果:术后3个月随访率100%,其中绝对有效18例(18/21,85.7%),相对有效(术后仍有色素沉着,但范围减小)3例(3/21,14.3%)。髂静脉支架均通畅,同期行大隐静脉射频治疗患者射频治疗段大隐静脉主干均闭合良好。术后6个月随访率71.4%(15/21),其中绝对有效14例(14/15,93.3%),相对有效(术后仍有色素沉着,但范围减小)1例(1/15,6.7%)。髂静脉支架均通畅,同期行大隐静脉射频治疗患者射频治疗段大隐静脉主干均闭合良好。结论:经大隐静脉入路髂静脉狭窄的介入治疗技术在日间治疗模式中可行,有明确优势,近期疗效满意。

CT静脉造影与彩色多普勒超声检查在左髂静脉压迫综合征诊断中的临床价值

目的 研究CT静脉造影(CTV)与彩色多普勒超声(CDS)检查在左髂静脉压迫综合征(IVCS)诊断中的临床价值。方法 选取2022年1月至2023年6月入大庆龙南医院的81例左侧静脉曲张患者作为观察对象,所有患者均接受数字减影血管造影(DSA)检查,参考下肢静脉检查结果有无左IVCS分别作为观察组(n=27)与对照组(n=54)。两组患者均接受CTV或者CDS检查,比较两组患者的CTV左髂静脉前后径、CDS参数(压力梯度、血流速度、前后径),同时比较单一CTV、CDS与CTV联合CDS诊断左IVCS准确性,并采用受试者操作特征(ROC)曲线评估CTV、CDS单独及联合检测对IVCS的诊断价值。结果 观察组患者CTV及CDS左髂静脉前后径分别为(6.09±1.38)、(3.02±0.47) mm,均明显低于对照组[(7.41±1.72)、(5.11±0.58) mm],压力梯度、血流速度分别为(2.69±0.48) mmHg、(40.47±9.25) cm/s,均明显高于对照组[(0.89±0.32) mmHg、(27.53±6.92) cm/s],差异均有统计学意义(P<0.05)。左IVCS诊断中CTV左髂静脉前后径、CDS左髂静脉前后径及联合检查的准确率依次为87.95%、84.34%、91.57%。ROC曲线显示,以10.00 mm为临界值,左IVCS诊断中CTV的ROC曲线下面积(AUC)为0.905,灵敏性为81.47%,特异性为90.38%;CDS的AUC为0.839,灵敏性为74.09%,特异性为88.46%;CTV联合CDS的AUC为0.935,灵敏性为96.28%,特异性为86.49%。结论 左IVCS诊断中IVCS、CDS均具有良好效果,但两种技术联合诊断的准确性、灵敏性更高,早期阶段可为左IVCS诊断提供参考依据。

导管溶栓联合髂静脉球囊扩张对急性下肢深静脉血栓合并Cockett综合征并发症及凝血功能的影响

目的 分析导管溶栓联合髂静脉球囊扩张对急性下肢深静脉血栓(DVT)合并Cockett综合征病人疗效、并发症及凝血功能的影响。方法 2018年3月~2022年9月收治的急性DVT合并Cockett综合征病人102例,按治疗方法分为两组,研究组53例,采用导管溶栓联合髂静脉球囊扩张治疗;对照组49例,采用导管溶栓治疗。两组病人术后均随访1年。比较两组病人血栓清除情况、患肢消肿情况、下肢血流动力学、凝血功能、外周血炎症因子、并发症及血栓复发情况。结果 研究组血栓清除分级优于对照组,差异有统计学意义(P<0.05)。对照组术前、术后1年患侧与健侧膝上腿围周径差分别为(8.02±1.41)cm、(2.89±0.32)cm,研究组分别为(8.19±1.38)cm、(2.57±0.29)cm,对照组术前、术后1年患侧与健侧膝下腿围周径差分别为(6.84±1.18)cm、(2.13±0.38)cm,研究组分别为(6.63±1.09)cm、(1.76±0.32)cm,差异有统计学意义(P<0.05),研究组术后1年更低(P<0.05)。对照组术前、术后3天股静脉平均血流速度分别为(24.75±4.03)cm/s、(28.82±4.29)cm/s,研究组分别为(24.02±3.86)cm/s、(30.94±4.37)cm/s,对照组术前、术后3天股静脉血流量分别为(13.02±2.12)ml/s、(15.05±2.29)ml/s,研究组分别为(13.36±2.09)ml/s、(16.26±2.34)ml/s,差异有统计学意义(P<0.05),研究组术后3天更高(P<0.05)。对照组术前、术后3天凝血酶原时间分别为(22.93±2.04)s、(18.13±1.34)s,研究组分别为(23.24±1.99)s、(17.29±1.21)s,对照组术前、术后3天凝血酶时间分别为(24.86±2.31)s、(21.04±1.75)s,观察组分别为(24.13±2.16)s、(19.89±1.53)s,对照组术前、术后3天活化部分凝血活酶时间分别为(59.21±3.92)s、(49.13±3.02)s,观察组分别为(60.17±3.85)s、(47.09±2.98)s,差异有统计学意义(P<0.05),研究组术后3天更低(P<0.05)。研究组术前肿瘤坏死因子(TNF)-α、血小板活化因子(PAF)、血栓素B2(TXB2)分别为(31.91±4.89)ng/L、(14.59±2.36)pg/ml、(213.12±30.98)pg/ml,术后3天分别为(36.24±4.29)ng/L、(16.12±2.59)pg/ml、(239.86±32.85)pg/ml,差异有统计学意义(P<0.05),研究组术后3天TNF-α、PAF、TXB2更高(P<0.05)。两组总并发症发生率比较差异无统计学意义(P>0.05)。研究组血栓复发率低于对照组(3.77%比16.33%,P<0.05)。结论 导管溶栓联合髂静脉球囊扩张治疗急性DVT合并Cockett综合征可增强血栓清除效果,并改善患肢肿胀情况及下肢血流动力学及凝血功能,降低血栓复发风险,安全可靠,但该治疗方案可介导炎症反应发生,术后应积极实施合理抗炎治疗。

髂静脉内支架植入术治疗深静脉血栓后综合征的疗效分析

目的对髂静脉支架治疗深静脉血栓后综合征疗效进行评价。方法回顾性选取2020年1月—2023年6月柳州市柳铁中心医院收治的68例深静脉血栓后综合征(post-thrombotic syndrome,PTS)患者临床资料,根据其治疗方式分为支架治疗组(40例)和保守治疗组(28例)。支架治疗组行髂静脉球囊扩张成型支架置入术治疗,保守治疗组行保守治疗,比较两组患者Villalta评分、血管通畅率。结果治疗前,两组患者Villalta评分比较,差异无统计学意义(P>0.05);治疗后,两组患者术后3个月、6个月、12个月Villalta评分较术前均降低,且支架治疗组患者术后3个月、6个月Villalta评分(10.81±2.97)分、(8.62±2.68)分均低于保守治疗组的(12.54±3.81)分、(9.81±1.64)分,差异有统计学意义(t=2.103、2.089,P均<0.05)。支架治疗组患者治疗3个月、6个月和12个月的血管通畅率80.00%(32/40)、90.00%(36/40)和95.00%(38/40)均高于对照组的57.14%(16/28)、67.86%(19/28)、75.00%(21/28),差异有统计学意义(P均<0.05)。结论髂静脉内支架植入术治疗下肢静脉闭塞性疾病可以提高术后静脉血管通畅率,减轻下肢临床症状,提高患者术后生活质量。

Challenging anticoagulation therapy for multiple primary malignant tumors combined with thrombosis:A case report and review of literature

BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality.Management of its etiology and anticoagulation treatment is intricate,necessitating a comprehensive consideration of various factors,including the bleeding risk,dosage,specific anticoagulant medications,and duration of therapy.Herein,a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience.CASE SUMMARY An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d.Considering her medical history and relevant post-admission investigations,it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors,including multiple primary malignant tumors,iliac venous compression syndrome,previous novel coronavirus infection,and inadequate treatment for prior thrombotic events.However,the selection of appropriate anticoagulant medications,determination of optimal drug dosages,and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia,decreased quantitative fibrinogen levels,and renal insufficiency.CONCLUSION Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis.Individualized anticoagulation therapy is required for complex thrombosis.

髂股静脉支架在髂静脉压迫综合征中的应用体会

目的探讨髂股静脉支架治疗髂静脉压迫综合征(ILVS)的临床疗效及安全性。方法收集2023年1月至2023年10月于国家中医针灸临床医学研究中心/天津中医药大学第一附属医院成功完成髂股静脉支架置入术的9例髂静脉压迫综合征患者的临床资料。观察所有患者的治疗情况,包括支架置入情况、一期通畅情况、静脉临床严重程度评分(VCSS)、阿伯丁静脉曲张问卷(AVVQ)评分及不良事件发生情况。结果9例患者均成功完成髂股静脉支架置入术。治疗后3个月随访期间,8例患者下肢血流一期通畅,1例患者发生了支架内再狭窄。所有患者术后3个月VCSS、AVVQ评分均低于术前,差异均有统计学意义(P﹤0.05)。随访3个月内未见支架内再狭窄、肺栓塞、血肿、死亡等主要不良事件,无临床驱动的靶病变血管重建。结论髂股静脉支架在髂静脉综合征治疗中的应用效果佳,血管一期通畅良好,术后并发症少。

药物-机械导管溶栓联合Venovo静脉支架植入治疗髂静脉压迫伴急性下肢深静脉血栓形成

目的评价药物-机械导管溶栓(pharmacomechanical catheter-directed thrombolysis,PCDT联合Venovo(Bard)静脉支架植入治疗髂静脉压迫综合征(iliac vein compression syndrome,IVCS)伴急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的短期疗效及安全性。方法回顾性分析2022年7月至2022年12月于郑州大学第五附属医院采用PCDT联合Venovo静脉支架植入治疗IVCS伴急性下肢DVT的23例患者临床资料,评价患者手术前后下肢周径差及术后血栓清除率。于术后第1、3、6个月进行门诊随访,记录患者静脉临床严重程度评分(venous clinical severity score,VCSS)并检查支架通畅情况。结果所有手术均获成功,靶病变血栓均达到完全清除(清除率>95%),同期植入Venovo髂静脉支架23枚。术后6个月随访期间未见支架发生移位、断裂或脱落等情况,无死亡病例。23例患者下肢患-健侧周径差(大腿、小腿)分别由术前(5.59±0.93)cm、(3.52±0.85)cm下降为术后(1.43±0.68)cm、(1.41±0.72)cm,差异具有统计学意义(均P<0.05)。术后第6个月时VCSS较术前显著降低(5.4±1.1 vs 8.0±1.9,P<0.05),差异具有统计学意义。术后第6个月时一期通畅率为95.7%(22/23),手术再干预率为4.3%。结论应用PCDT联合Venovo静脉支架植入治疗IVCS伴急性下肢DVT安全有效,具有较好的临床应用前景。

下腔静脉滤器脱落移位至右髂外静脉1例

患者男,87岁,左下肢肿胀、疼痛1月余,加重并红肿4天;患慢性阻塞性肺疾病多年,具体不详。查体:左大腿内侧至小腿上段肿胀,皮肤潮红、皮温升高,波动感(+)。下肢静脉超声见左侧腘静脉至胫后静脉局部血栓形成。于左小腿抽出暗红色脓液,细菌涂片显示革兰氏阳性球菌(++)。