血栓性髂静脉压迫综合征腔内治疗进展

doi:10.3760/cma.j.issn.1007-1245.2024.12.004

摘要/Abstract

摘要：

血栓性髂静脉压迫综合征（TIVCS），是由于髂静脉受压引起髂静脉回流受阻和血液瘀滞后继发同侧下肢深静脉血栓形成（DVT）。若不进行有效治疗，急性期可致肺栓塞，危害患者生命健康；后期可发展为下肢静脉血栓后综合征（PTS），影响患者生活质量。目前，腔内治疗是主要治疗手段，包括下腔静脉滤器（IVCF）置入术、导管接触性溶栓（CDT）、机械性血栓清除术（PMT）、球囊血管成形术及支架置入术，但对于处理髂静脉狭窄时机仍存在争议。该文就TIVCS的腔内治疗进展作一综述。

关键词:

血栓性髂静脉压迫综合征, 深静脉血栓形成, 腔内治疗, 髂静脉支架, 血栓清除术, 进展

Abstract:

Thrombotic iliac vein compression syndrome (TIVCS) is caused by iliac vein compression, resulting in iliac vein return obstruction and blood stasis, followed by ipsilateral lower extremity deep venous thrombosis (LEDVT). Without effective treatment, it can lead to pulmonary embolism in the acute stage, seriously endangering the life and health, and may develop into lower extremity post thrombotic syndrome (PTS) in the later stage, which seriously affect the quality of life. At present, endovenous treatment is the main therapy, including inferior vena cava filter (IVCF) implantation, catheter directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), balloon angioplasty, and stent implantation. However, there is still controversy about the timing of iliac vein stenosis treatment, and there is no unified standard. Therefore, this article reviews the progress of endovenous treatment for TIVCS.

Key words:

Thrombotic iliac vein compression syndrome, Deep vein thrombosis, Endovenous treatment, Iliac vein stent, Thrombectomy, , Progress

叶飞霆闫磊磊张成德.

血栓性髂静脉压迫综合征腔内治疗进展 [J]. 国际医药卫生导报, 2024, 30(12): 1950-1954.

Ye Feiting, Yan Leilei, Zhang Chengde.

Progress in endovenous treatment of thrombotic iliac vein compression syndrome [J]. International Medicine and Health Guidance News, 2024, 30(12): 1950-1954.

参考文献

[1] 中国医师协会血管外科医师分会静脉学组. 常见静脉疾病诊治规范(2022年版)[J/CD]. 中华普通外科学文献(电子版),2022,16(4):255-272. DOI:10.3877/cma.j.issn.1674- 0793.2022.04.002.
[2] 朱威. 下肢深静脉血栓形成的溶栓治疗进展[J]. 海南医学,2022,33(9):1190-1193. DOI:10.3969/j.issn.1003-6350. 2022.09.027.
[3] Esposito A, Charisis N, Kantarovsky A,et al. A comprehensive review of the pathophysiology and clinical importance of Iliac vein obstruction[J]. Eur J Vasc Endovasc Surg, 2020,60(1):118-125.DOI: 10.1016/j.ejvs.2020.03.020.
[4] Armenta Flores R, Armenta-Villalobos D, Ramirez-Centeno E,et al. May thurner syndrome: sixty years later[J]. Phlebology, 2022,37(1):5-13.DOI: 10.1177/02683555211045202.
[5] Dix C, Clements W, Gibbs H,et al. Venous anomalies and thromboembolism[J]. Thromb J,2023,21(1):45.DOI: 10.1186/s12959-023-00484-5.
[6] Kaltenmeier CT, Erben Y, Indes J,et al. Systematic review of May-Thurner syndrome with emphasis on gender differences[J]. J Vasc Surg Venous Lymphat Disord,2018,6(3):399-407.e4.DOI: 10.1016/j.jvsv.2017.11.006.
[7] Li HL, Kwan KJS, Chan YC,et al. Prevalence and predictors of radiological left common iliac vein compression in asymptomatic patients[J]. J Vasc Surg Venous Lymphat Disord,2024,12(1):101661.DOI: 10.1016/j.jvsv.2023. 07.011.
[8] 倪浩伦. 髂静脉狭窄与下肢深静脉血栓形成关系研究[D].南京:南京大学,2022.DOI:10.27235/d.cnki.gnjiu.2021. 001079.
[9] Jiang XD, Ye SL, Zhang M,et al. Clinical implications of hemodynamic analysis for the three-dimension iliac vein model with different stenosis[J]. Heliyon, 2023 ,9(2):e13681.DOI: 10.1016/j.heliyon.2023.e13681.
[10] Zhu Q, Yang L, Zhu H,et al. Prevalence of left iliac vein compression in an asymptomatic population and patients with left iliofemoral deep vein thrombosis: a multicenter cross-sectional study in southern China[J]. Phlebology, 2022,37(8):602-609.DOI: 10.1177/02683555221113111.
[11] Shi Y, Yuan Y, Gong M,et al. The association between iliac vein compression degree and characteristics of first diagnosed left lower extremity deep vein thrombosis[J]. Front Cardiovasc Med,2022,9:1073586.DOI: 10.3389/fcvm.2022.1073586.
[12] 许天泽,李晓强. 髂静脉受压综合征与下肢深静脉血栓形成相关性的研究进展[J]. 中华血管外科杂志,2021,6(1):68-71. DOI:10.3760/cma.j.cn101411-20200617-00060.
[13] Fereydooni A, Stern JR. Contemporary treatment of May-Thurner syndrome[J]. J Cardiovasc Surg (Torino), 2021,62(5):447-455.DOI: 10.23736/S0021-9509. 21.11889-0.
[14] Waheed KB, Mohammed HR, Salem KS,et al. Left lower limb deep venous thrombosis, May-Thurner syndrome and endovascular management[J]. Saudi Med J,2022,43(1):108-112.DOI: 10.15537/smj.2022.43.1.20210473.
[15] Jin S, Sun Z, Li X,et al. May-Thurner syndrome and the risk of pulmonary embolism in patients with acute deep venous thrombosis[J]. J Vasc Surg Venous Lymphat Disord, 2018,6(4):433-440.e1.DOI: 10.1016/j.jvsv.2018.01.007.
[16] Zhu Q, Chen D, Zhou C,et al. Percutaneous endovenous intervention without vena cava filter for acute proximal deep vein thrombosis secondary to iliac vein compression syndrome: preliminary outcomes[J]. Radiol Med,2021,126(5):729-736.DOI: 10.1007/s11547-020-01330-8.
[17] Nakamura H, Anzai H, Kadotani M. Less frequent post-thrombotic syndrome after successful catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis[J]. Cardiovasc Interv Ther,2021,36(2):237-245.DOI: 10.1007/s12928-020-00661-7.
[18] Qian C, Chen GP, Lou WS,et al. The perplexity of catheter-directed thrombolysis for deep venous thrombosis: the approaches play an important role[J]. J Thromb Thrombolysis,2021,51(3):757-766.DOI: 10.1007/s11239-020-02222-4.
[19] 王颖,王孝高,官泽宇,等. 低分子肝素联合普通肝素在下肢深静脉血栓形成导管直接溶栓中的应用[J]. 中华全科医学,2023,21(4):568-571. DOI:10.16766/j.cnki.issn.1674- 4152.002932.
[20] 马青,刘宗芬,孙波,等. 髂静脉受压综合征合并急性下肢深静脉血栓形成的腔内治疗进展[J]. 血管与腔内血管外科杂志,2023,9(6):701-704,709. DOI:10.19418/j.cnki.issn2096-0646.2023.06.13.
[21] 文飞亚,沈俐萍,陈江龙,等. 经皮机械血栓清除术联合导管接触性溶栓治疗亚急性期下肢深静脉血栓形成患者的疗效及安全性[J]. 血管与腔内血管外科杂志,2023,9(8):969-973,1011. DOI:10.19418/j.cnki.issn2096-0646.2023. 08.16.
[22] 蒲雲飞. 髂静脉压迫性下肢深静脉血栓的腔内治疗进展[J]. 临床与病理杂志,2022,42(6):1485-1489. DOI:10.3978/j.issn.2095-6959.2022.06.034.
[23] Sutedjo J, Li Y, Gu J. Manual aspiration thrombectomy for acute and subacute inferior vena cava thrombosis and lower extremity deep venous thrombosis[J]. J Interv Med, 2019,1(4):197-204.DOI: 10.19779/j.cnki.2096-3602. 2018.04.02.
[24] Zhu QH, Zhou CY, Chen Y,et al. Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis: a prospective study of single-session endovascular protocol[J]. Eur J Vasc Endovasc Surg,2014,47(1):68-74.DOI: 10.1016/j.ejvs.2013.09.030.
[25] Kim EH, Lee HG, Oh JS, et al. Application of manual aspiration thrombectomy in the treatment of deep vein thrombosis in cancer patients: Descriptive retrospective cohort study[J]. PLoS One,2021,16(8):e0255539.DOI: 10.1371/journal.pone.0255539.
[26] 何楠,唐小斌,梁紫轲,等. 一站式腔内治疗急性深静脉血栓形成合并髂静脉压迫综合征的临床价值[J]. 中华血管外科杂志,2023,8(2):187-192. DOI:10.3760/cma.j.cn101411- 20230406-00029.
[27] Wortmann JK, Barco S, Fumagalli RM,et al. Coagulation-monitored, dose-adjusted catheter-directed thrombolysis or pharmaco-mechanical thrombus removal in deep vein thrombosis[J]. Vasa,2023,52(6):416-422.DOI: 10.1024/0301-1526/a001097.
[28] 李勤,朱俊龙,何延政,等. 机械性血栓清除术与单纯经皮导管接触性溶栓术治疗急性下肢深静脉血栓合并髂静脉压迫综合征的临床疗效[J]. 血管与腔内血管外科杂志,2022,8(6):666-670. DOI:10.19418/j.cnki.issn2096-0646.2022. 06.06.
[29] Aurshina A, Chait J, Kibrik P,et al. Efficacy of balloon venoplasty alone in the correction of nonthrombotic iliac vein lesions[J]. J Vasc Surg Venous Lymphat Disord, 2019,7(5):665-669.DOI: 10.1016/j.jvsv.2019.03.004.
[30] Funatsu A, Anzai H, Komiyama K,et al. Stent implantation for May-Thurner syndrome with acute deep venous thrombosis: acute and long-term results from the ATOMIC (AcTive stenting for May-Thurner Iliac Compression syndrome) registry[J]. Cardiovasc Interv Ther, 2019,34(2):131-138.DOI: 10.1007/s12928-018- 0532-y.
[31] Farina R, Foti PV, Iannace FA,et al. May Thurner syndrome: description of a case with unusual clinical onset[J]. J Ultrasound, 2022,25(2):309-313.DOI: 10.1007/s40477-020-00497-0.
[32] Chen ZH, Huang Y, Wang LP,et al. Preliminary study of hemodynamics of iliac venous compression syndrome using magnetic resonance imaging[J]. J Vasc Surg Venous Lymphat Disord, 2022,10(1):131-138.e3.DOI: 10.1016/j.jvsv.2021.09.011.
[33] Taha MA, Busuttil A, Bootun R,et al. Clinical outcomes and overview of dedicated venous stents for management of chronic iliocaval and femoral deep venous disease[J]. Vascular,2022,30(2):320-330.DOI: 10.1177/1708538121989860.
[34] Lichtenberg MKW, Stahlhoff WF, Stahlhoff S,et al. Venovo venous stent for treatment of non-thrombotic or post-thrombotic iliac vein lesions - long-term efficacy and safety results from the Arnsberg venous registry[J]. Vasa,2021,50(1):52-58.DOI: 10.1024/0301-1526/a000893.
[35] Powell T, Raju S, Jayaraj A. Comparison between a dedicated venous stent and standard composite Wallstent-Z stent approach to iliofemoral venous stenting: intermediate-term outcomes[J]. J Vasc Surg Venous Lymphat Disord,2023,11(1):82-90.e2.DOI: 10.1016/j.jvsv.2022.05.012.
[36] Robertson B, Shapiro J, Muck A,et al. Venous stent patency is independent of total stented length in nonthrombotic iliac vein and post-thrombotic venous stenoses[J]. J Vasc Surg Venous Lymphat Disord, 2023,11(2):339-345.DOI: 10.1016/j.jvsv.2022.07.006.
[37] Liu Q, Liu F, Lü P,et al. Current status and prospect of stent placement for May-Thurner syndrome[J]. Curr Med Sci, 2021,41(6):1178-1186.DOI: 10.1007/s11596-021- 2481-4.
[38] Saleem T, Raju S. An overview of in-stent restenosis in iliofemoral venous stents[J]. J Vasc Surg Venous Lymphat Disord,2022,10(2):492-503.e2.DOI: 10.1016/j.jvsv.2021.10.011.
[39] Kim MS, Park HS, Hong HP,et al. Risk factors for stent occlusion after catheter-directed thrombolysis and iliac vein stenting in the treatment of May-Thurner syndrome with iliofemoral deep vein thrombosis: a retrospective cohort study[J]. Quant Imaging Med Surg, 2022,12(12):5420-5432.DOI: 10.21037/qims-22-515.
[40] Jayaraj A, Fuller R, Raju S,et al. In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction[J]. J Vasc Surg Venous Lymphat Disord,2022,10(1):42-51.DOI: 10.1016/j.jvsv.2021.06.009.
[41] 魏露,陈伟,熊智巍,等. 置管溶栓联合髂静脉腔内治疗髂静脉压迫综合征伴下肢深静脉血栓形成的临床效果观察[J]. 实用医院临床杂志,2022,19(1):89-93. DOI:10.3969/j.issn.1672-6170.2022.01.023.
[42] 陈陈准,陈秋文,林裕辉,等. 一期治疗髂静脉狭窄对急性下肢深静脉血栓形成合并髂静脉压迫综合征的疗效[J]. 广东医学,2022,43(3):316-320. DOI:10.13820/j.cnki.gdyx. 20211642.
[43] 朱威,卢冉,孙浩博,等. 一期或分期行腔内治疗对下肢深静脉血栓合并髂静脉压迫综合征患者疗效的影响[J]. 广西医学,2022,44(13):1457-1461. DOI:10.11675/j.issn.0253- 4304.2022.13.04.
[44] 吴正阳,张文广,周朋利,等. 球囊不同扩张时机在Cockett综合征合并左下肢深静脉血栓中的对比观察[J]. 中华医学杂志,2018,98(4):299-301. DOI:10.3760/cma.j.issn.0376- 2491.2018.04.012.
[45] Jiang C, Zhao Y, Wang X,et al. Midterm outcome of pharmacomechanical catheter-directed thrombolysis combined with stenting for treatment of iliac vein compression syndrome with acute iliofemoral deep venous thrombosis[J]. J Vasc Surg Venous Lymphat Disord, 2020,8(1):24-30.DOI: 10.1016/j.jvsv.2019.03.020.
[46] Zhu Y, Li L, Liu Z,et al. Single-stage treatment of angiojet rheolytic thrombectomy and stenting for Iliac vein compression syndrome with secondary acute Iliofemoral deep vein thrombosis[J]. Ann Vasc Surg, 2019,61:384-393.DOI: 10.1016/j.avsg.2019.02.028.
[47] 姜广伟,丁殿柱,张晓宇,等. 一站式腔内介入治疗髂静脉压迫综合征继发下肢深静脉血栓疗效观察[J]. 浙江大学学报(医学版),2022,51(3):341-349. DOI:10.3724/zdxbyxb- 2022-0121.
[48] 翟刚,李静静,索飞飞,等.左下肢深静脉血栓形成合并髂静脉压迫综合征不同治疗方式疗效分析[J].中国医学工程,2023,31(10):91-95.DOI:10.19338/j.issn.1672-2019. 2023.10.019.