腔内治疗髂静脉受压综合征合并下肢深静脉血栓形成研究进展
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摘要
随着介入器材的发展和技术的进步,目前临床上血管腔内技术已广泛应用于静脉疾病的治疗,导管接触性溶栓相对于传统溶栓具有更高的效率,血栓清除也更彻底,球囊扩张联合支架成形术可以在创伤极其微小的情况下解决髂静脉狭窄病变,又可以保持管腔长期通畅。然而对于cockett综合征合并髂股静脉血栓形成的患者,髂静脉狭窄和血栓两种疾病同时存在,且在治疗过程中两者具有相互影响作用。一方面,髂静脉狭窄使血液的流出道受阻,一定程度上会对溶栓效果产生不利影响,但同时可能也会降低肺栓塞的风险;另一方面,静脉血栓可能掩盖或扩大髂静脉病变,影响髂静脉病变的处理,同时血栓也会继发于髂静脉病变。基于此,导管接触性溶栓与球囊扩张或支架成形术的简单联合应用可能无法达到1+1=2的效果,正确认识两者之间的作用关系,并合理利用血管腔内技术,才可能达到1+1=2,甚至1+1>2的效果。
With the development of interventional equipment and techniques,the endovascular techniques have been widely used in treatment of venous diseases,as compared with traditional thrombolysis method,the catheter contacting thrombolysis has higher efficiency and better results.The percutaneous transluminal angioplasty(PTA) and stenting are minimally invasive treatment methods for iliac vein stenosis, with significant curative effects.However for the patients with Cockett syndrome complicated by deep venous thrombosis of lower limbs. on one hand,the iliac vein stenosis result in the obstruction of blood outflow tract flow that will have adverse effects on thrombolysis effects to a certain extent,however,which may simultaneously reduce the risk of pulmonary embolism,on the other hand,thrombosis may be a reason for misdiagnosis of Cockett syndrome,which may magnify the range of iliac vein lesions,and thrombus is likely to secondary to iliac vein lesions.Based on that,the simple combination application of catheter contacting thrombolysis and percutaneous transluminal angioplasty(PTA) as well as stenting may not be able to achieve the synergic effects,therefore, the thorough understanding of the mutual effect and a rational utilization of endovascular techniques can bring synergic effects.
With the development of interventional equipment and techniques,the endovascular techniques have been widely used in treatment of venous diseases,as compared with traditional thrombolysis method,the catheter contacting thrombolysis has higher efficiency and better results.The percutaneous transluminal angioplasty(PTA) and stenting are minimally invasive treatment methods for iliac vein stenosis, with significant curative effects.However for the patients with Cockett syndrome complicated by deep venous thrombosis of lower limbs. on one hand,the iliac vein stenosis result in the obstruction of blood outflow tract flow that will have adverse effects on thrombolysis effects to a certain extent,however,which may simultaneously reduce the risk of pulmonary embolism,on the other hand,thrombosis may be a reason for misdiagnosis of Cockett syndrome,which may magnify the range of iliac vein lesions,and thrombus is likely to secondary to iliac vein lesions.Based on that,the simple combination application of catheter contacting thrombolysis and percutaneous transluminal angioplasty(PTA) as well as stenting may not be able to achieve the synergic effects,therefore, the thorough understanding of the mutual effect and a rational utilization of endovascular techniques can bring synergic effects.
引文
1 May R.The cause of predominantly sinistral occurrence of thrombosis of the pelvic veins.Angiology,1957,8:419.
2 Cockett FB,Thomas ML.The iliac compression syndrome.British Journal of Surgery,1965,52:816.
3 Dogan OF,Boke E.Three cases with May-Thurner syndrome:a possibly under-reported disorder.Vasa Zeitschrift Für Gefsskrankheiten,2005,34:147-151.
4 Long C,Hui Z,Zhang F.Iliac vein compression syndrome in an asympto- matic patient population:a prospective study.Chinese Medical Journal,2017,130:1269-1275.
5 Segal JB,Streiff MB,Hofmann LV,et al.Management of venous thromb- oembolism:a systematic review for a practice guideline.Ann Intern Med ,2007,146:211-222.
6 Berger A,Jaffe JW,York TN.Iliac compression syndrome treated with stent placement.Journal of Vascular Surgery,1995,21:510.
7 Meissner MH.Thrombolytic therapy for acute deep vein thrombosis and the venous registry.Reviews in Cardiovascular Medicine,2002,3:S53-S60.
8 Enden T,Sandvik L,Klow N,et al.Catheter-directed Venous Thromboly- sis in acute iliofemoral vein thrombosis-the CaVenT study:rationale and design of a multicenter,randomized,controlled,clinical trial.American Heart Journal,2007,154:808-814.
9 Gogalniceanu P,Johnston CJC,Khalid U,et al.Indications for Thrombol- ysis in Deep Venous Thrombosis.European Journal of Vascular & Endovascular Surgery,2009,38:192-198.
10 Kearon C,Akl EA,Ornelas J,et al.Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report.Chest,2016,149:315-352.
11 中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南第2版.中华外科杂志,2012,50:53-57.
12 蒋米尔,张培华主编.临床血管外科学.第3版.北京:科学出版社,2010.863.
13 袁凯.下肢深静脉血栓形成的诊断与导管溶栓进展.医学研究杂志,2008,8:27-30.
14 Ylva H,Tone E,Carl S,et al.Determinants of early and long-term efficacy of catheter-directed thrombolysis in proximal deep vein thrombosis.Journal of Vascular & Interventional Radiology,2013,24:17-24.
15 Baekgaard N,Broholm RS,Jorgensen M,et al.Long-term results using catheter-directed thrombolysis in 103 lower limbs with acute iliofemoral venous thrombosis.European Journal of Vascular & Endovascular Surgery,2010,39:112-117.
16 冯琦琛,李选,李天润,等.合并Cockett综合征的急性下肢深静脉血栓形成患者髂静脉扩张成形时机对导管直接溶栓持续时间的影响.中国微创外科杂志,2013,13:116-118.
17 卢鑫,曾国斌,林龙潜,等.腘静脉置管溶栓联合静脉球囊扩张治疗急性中央型下肢深静脉血栓形成.中国血管外科杂志:电子版,2014,6:110-113.
18 董国祥.应重视髂静脉压迫综合征的诊断和治疗.中国血管外科杂志:电子版,2012,4:1-5.
19 Raju S.Endovenous treatment of patients with iliac-caval venous obstr- uction.Journal of Cardiovascular Surgery,2008,49:27-33.
20 Kim JY,Choi D,Ko YG,et al.Percutaneous Treatment of Deep Vein Thrombosis in May-Thurner Syndrome.Cardiovascular & Interventional Radiology,2006,29:571-575.
21 Azarbal A,Santo V,Moneta G.How should we treat May-Thurner syndrome and other causes of iliac vein obstruction? Examining the evidence.Interventional Cardiology,2014,6:95-101.
22 Ye K,Lu X,Li W,et al.Long-term outcomes of stent placement for symptomatic nonthrombotic iliac vein compression lesions in chronic venous disease.Journal of Vascular & Interventional Radiology,2012,23:502-503.
23 Ibrahim W,Al SZ,Hasan H,et al.Endovascular management of may-thurner syndrome.Annals of Vascular Diseases,2012,5:217.
24 李晓强,桑宏飞,戎建杰,等.左髂静脉狭窄或闭塞的介入治疗.中华普通外科杂志,2008,23:190-192.
25 顾建平,徐克,滕皋军.下肢深静脉血栓形成介入治疗规范的专家共识.中华放射学杂志,2011,45:293-296.
26 董国祥.下肢深静脉血栓形成病例中髂静脉压迫综合征的外科治疗.中国医学科学院学报,2007,29:51-54.
27 Carr S,Chan K,Rosenberg J,et al.Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis.Journal of Vascular & Interventional Radiology Jvir,2012,23:1467-1472.
28 Meng QY,Li XQ,Qian AM,et al.Endovascular treatment of iliac vein compression syndrome.Chin Med J (Engl),2011,124:3281-3284.
29 Kwak HS,Han YM,Lee YS,et al.Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis:early and late results.Journal of Vascular & Interventional Radiology,2005,16:815-822.
30 Hartung O,Loundou AP.Endovascular management of chronic disabling ilio-caval obstructive lesions:long-term results.European Journal of Vascular & Endovascular Surgery,2009,38:118-124.
31 Matsuda A,Yamada N,Ogihara Y,et al.Early and long-term outcomes of venous stent implantation for iliac venous stenosis after catheter-directed thrombolysis for acute deep vein thrombosis.Circulation Journal Official Journal of the Japanese Circulation Society,2014,78:1234-1239.
32 刘凯,段鹏飞,倪才方.髂静脉支架置入后行置管溶栓治疗急性下肢深静脉血栓形成八例.中华普通外科杂志,2016,31:339-340.
33 Mahnken AH,Thomson K,Haan MD,et al.CIRSE Standards of Practice Guidelines on Iliocaval Stenting.Cardiovascular & Interventional Radiology,2014,37:889-897.
34 张安冬,高涌,聂中林,等.腔内治疗髂静脉受压综合征的疗效分析.中国普通外科杂志,2016,25:1751-1756.
35 Neglén P,Raju S.Balloon dilation and stenting of chronic iliac vein obstruction:technical aspects and early clinical outcome.Journal of Endovascular Therapy,2000,7:79-91.
36 Wahlgren CM,Wahlberg E,Olofsson P.Endovascular treatment in postthrombotic syndrome.Vascular & Endovascular Surgery,2010,44:356-360.
37 Hartung O,Lugli M,Nicolini P,et al.Stenting for Iliac Veins Post-thrombotic Obstructive Lesions:Results of a Multicentric Retrospective Study.Journal of Vascular Surgery,2010,51:790-790.
38 Park JY,Ahn JH,Jeon YS,et al.Iliac vein stenting as a durable option for residual stenosis after catheterdirected thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome.Phlebology,2014,29:461-470.
39 虞丰,李晓强.髂静脉受压综合征腔内治疗继发支架内和对侧血栓形成.中华普通外科杂志,2016,31:967-968.
40 焦健,于小滨,李晓强.髂静脉受压综合征的腔内治疗:112例报告.中国微创外科杂志,2016,16:879-883.
41 Neglén P,Darcey R,Olivier J,et al.Bilateral stenting at the iliocaval confluence.Journal of Vascular Surgery,2010,51:1457-1466.
42 张喜成,奚斌,黄才安,等.髂静脉支架植入局部流场的粒子图像测速技术研究.中华实验外科杂志,2015,32:197.
43 Xicheng Z,Zhaolei C,Yun S,et al.Influence of Iliac Vein Stent Implantation on the Contralateral Iliac Vein.Vasc Endovascular Surgery,2015,19:119-123.
44 Goldhaber SZ,Tapson VF.A prospective registry of 5451 patients with ultrasound-confirmed deep vein thrombosis.American Journal of Cardiology,2004,93:259-262.
45 The PREPIC Study Group.Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism:the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study.Circulation,2006,18:187-188.
46 钟武,赖雪,陈睦虎,等.急性下肢深静脉血栓植管溶栓治疗与下腔静脉滤器植入的临床意义.四川医学,2014,35:315-316.
47 中华医学会放射学分会介入学组.下肢深静脉血栓形成介入治疗规范的专家共识.中华放射学杂志,2011,45:293-296.
48 肖乐,龚昆梅,王昆华,等.无滤器保护导管溶栓治疗早期左下肢深静脉血栓.中华外科杂志,2012,50:15-18.
49 张皓,薛冠华,梁卫,等.下腔静脉滤器在急性下肢深静脉血栓形成导管溶栓治疗中的必要性探讨.中华普通外科杂志,2010,25:543-545.
2 Cockett FB,Thomas ML.The iliac compression syndrome.British Journal of Surgery,1965,52:816.
3 Dogan OF,Boke E.Three cases with May-Thurner syndrome:a possibly under-reported disorder.Vasa Zeitschrift Für Gefsskrankheiten,2005,34:147-151.
4 Long C,Hui Z,Zhang F.Iliac vein compression syndrome in an asympto- matic patient population:a prospective study.Chinese Medical Journal,2017,130:1269-1275.
5 Segal JB,Streiff MB,Hofmann LV,et al.Management of venous thromb- oembolism:a systematic review for a practice guideline.Ann Intern Med ,2007,146:211-222.
6 Berger A,Jaffe JW,York TN.Iliac compression syndrome treated with stent placement.Journal of Vascular Surgery,1995,21:510.
7 Meissner MH.Thrombolytic therapy for acute deep vein thrombosis and the venous registry.Reviews in Cardiovascular Medicine,2002,3:S53-S60.
8 Enden T,Sandvik L,Klow N,et al.Catheter-directed Venous Thromboly- sis in acute iliofemoral vein thrombosis-the CaVenT study:rationale and design of a multicenter,randomized,controlled,clinical trial.American Heart Journal,2007,154:808-814.
9 Gogalniceanu P,Johnston CJC,Khalid U,et al.Indications for Thrombol- ysis in Deep Venous Thrombosis.European Journal of Vascular & Endovascular Surgery,2009,38:192-198.
10 Kearon C,Akl EA,Ornelas J,et al.Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report.Chest,2016,149:315-352.
11 中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南第2版.中华外科杂志,2012,50:53-57.
12 蒋米尔,张培华主编.临床血管外科学.第3版.北京:科学出版社,2010.863.
13 袁凯.下肢深静脉血栓形成的诊断与导管溶栓进展.医学研究杂志,2008,8:27-30.
14 Ylva H,Tone E,Carl S,et al.Determinants of early and long-term efficacy of catheter-directed thrombolysis in proximal deep vein thrombosis.Journal of Vascular & Interventional Radiology,2013,24:17-24.
15 Baekgaard N,Broholm RS,Jorgensen M,et al.Long-term results using catheter-directed thrombolysis in 103 lower limbs with acute iliofemoral venous thrombosis.European Journal of Vascular & Endovascular Surgery,2010,39:112-117.
16 冯琦琛,李选,李天润,等.合并Cockett综合征的急性下肢深静脉血栓形成患者髂静脉扩张成形时机对导管直接溶栓持续时间的影响.中国微创外科杂志,2013,13:116-118.
17 卢鑫,曾国斌,林龙潜,等.腘静脉置管溶栓联合静脉球囊扩张治疗急性中央型下肢深静脉血栓形成.中国血管外科杂志:电子版,2014,6:110-113.
18 董国祥.应重视髂静脉压迫综合征的诊断和治疗.中国血管外科杂志:电子版,2012,4:1-5.
19 Raju S.Endovenous treatment of patients with iliac-caval venous obstr- uction.Journal of Cardiovascular Surgery,2008,49:27-33.
20 Kim JY,Choi D,Ko YG,et al.Percutaneous Treatment of Deep Vein Thrombosis in May-Thurner Syndrome.Cardiovascular & Interventional Radiology,2006,29:571-575.
21 Azarbal A,Santo V,Moneta G.How should we treat May-Thurner syndrome and other causes of iliac vein obstruction? Examining the evidence.Interventional Cardiology,2014,6:95-101.
22 Ye K,Lu X,Li W,et al.Long-term outcomes of stent placement for symptomatic nonthrombotic iliac vein compression lesions in chronic venous disease.Journal of Vascular & Interventional Radiology,2012,23:502-503.
23 Ibrahim W,Al SZ,Hasan H,et al.Endovascular management of may-thurner syndrome.Annals of Vascular Diseases,2012,5:217.
24 李晓强,桑宏飞,戎建杰,等.左髂静脉狭窄或闭塞的介入治疗.中华普通外科杂志,2008,23:190-192.
25 顾建平,徐克,滕皋军.下肢深静脉血栓形成介入治疗规范的专家共识.中华放射学杂志,2011,45:293-296.
26 董国祥.下肢深静脉血栓形成病例中髂静脉压迫综合征的外科治疗.中国医学科学院学报,2007,29:51-54.
27 Carr S,Chan K,Rosenberg J,et al.Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis.Journal of Vascular & Interventional Radiology Jvir,2012,23:1467-1472.
28 Meng QY,Li XQ,Qian AM,et al.Endovascular treatment of iliac vein compression syndrome.Chin Med J (Engl),2011,124:3281-3284.
29 Kwak HS,Han YM,Lee YS,et al.Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis:early and late results.Journal of Vascular & Interventional Radiology,2005,16:815-822.
30 Hartung O,Loundou AP.Endovascular management of chronic disabling ilio-caval obstructive lesions:long-term results.European Journal of Vascular & Endovascular Surgery,2009,38:118-124.
31 Matsuda A,Yamada N,Ogihara Y,et al.Early and long-term outcomes of venous stent implantation for iliac venous stenosis after catheter-directed thrombolysis for acute deep vein thrombosis.Circulation Journal Official Journal of the Japanese Circulation Society,2014,78:1234-1239.
32 刘凯,段鹏飞,倪才方.髂静脉支架置入后行置管溶栓治疗急性下肢深静脉血栓形成八例.中华普通外科杂志,2016,31:339-340.
33 Mahnken AH,Thomson K,Haan MD,et al.CIRSE Standards of Practice Guidelines on Iliocaval Stenting.Cardiovascular & Interventional Radiology,2014,37:889-897.
34 张安冬,高涌,聂中林,等.腔内治疗髂静脉受压综合征的疗效分析.中国普通外科杂志,2016,25:1751-1756.
35 Neglén P,Raju S.Balloon dilation and stenting of chronic iliac vein obstruction:technical aspects and early clinical outcome.Journal of Endovascular Therapy,2000,7:79-91.
36 Wahlgren CM,Wahlberg E,Olofsson P.Endovascular treatment in postthrombotic syndrome.Vascular & Endovascular Surgery,2010,44:356-360.
37 Hartung O,Lugli M,Nicolini P,et al.Stenting for Iliac Veins Post-thrombotic Obstructive Lesions:Results of a Multicentric Retrospective Study.Journal of Vascular Surgery,2010,51:790-790.
38 Park JY,Ahn JH,Jeon YS,et al.Iliac vein stenting as a durable option for residual stenosis after catheterdirected thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome.Phlebology,2014,29:461-470.
39 虞丰,李晓强.髂静脉受压综合征腔内治疗继发支架内和对侧血栓形成.中华普通外科杂志,2016,31:967-968.
40 焦健,于小滨,李晓强.髂静脉受压综合征的腔内治疗:112例报告.中国微创外科杂志,2016,16:879-883.
41 Neglén P,Darcey R,Olivier J,et al.Bilateral stenting at the iliocaval confluence.Journal of Vascular Surgery,2010,51:1457-1466.
42 张喜成,奚斌,黄才安,等.髂静脉支架植入局部流场的粒子图像测速技术研究.中华实验外科杂志,2015,32:197.
43 Xicheng Z,Zhaolei C,Yun S,et al.Influence of Iliac Vein Stent Implantation on the Contralateral Iliac Vein.Vasc Endovascular Surgery,2015,19:119-123.
44 Goldhaber SZ,Tapson VF.A prospective registry of 5451 patients with ultrasound-confirmed deep vein thrombosis.American Journal of Cardiology,2004,93:259-262.
45 The PREPIC Study Group.Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism:the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study.Circulation,2006,18:187-188.
46 钟武,赖雪,陈睦虎,等.急性下肢深静脉血栓植管溶栓治疗与下腔静脉滤器植入的临床意义.四川医学,2014,35:315-316.
47 中华医学会放射学分会介入学组.下肢深静脉血栓形成介入治疗规范的专家共识.中华放射学杂志,2011,45:293-296.
48 肖乐,龚昆梅,王昆华,等.无滤器保护导管溶栓治疗早期左下肢深静脉血栓.中华外科杂志,2012,50:15-18.
49 张皓,薛冠华,梁卫,等.下腔静脉滤器在急性下肢深静脉血栓形成导管溶栓治疗中的必要性探讨.中华普通外科杂志,2010,25:543-545.