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....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.展开更多
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 ...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.展开更多
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 c...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.展开更多
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 res...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.展开更多
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 i...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.展开更多
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 hypertens...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.展开更多
BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality.Management of its etiology and anticoagulation treatment is intricate,necessitating a comprehensive consideration of v...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.展开更多
基金Regional Development Project of Fujian Province(2019Y3007)Military Logistics Research Projects(CLB18J060)Supporting Army Project of Zhangzhou City Government(ZZ2018KD01).
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
基金This work was supported by the National Key R&D Program of China(Grant no.2020YFC0862900,2020YFC0862902,2020YFC0862904 and 2020YFC0122203)the Beijing Municipal Science and Technology Project(Grant no.Z201100007920003)+1 种基金the National Natural Science Foundation of China(Grant no.32071311)Key R&D project of Shanxi Province(Grant no.201903D321149).
文摘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.
文摘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.
