Background： Iliac vein compression syndrome （1VCS） is an important cause of deep vein thrombosis, but the incidence oflVCS is still unclear. The purpose of this prospective study was to determine the incidence of I...Background： Iliac vein compression syndrome （1VCS） is an important cause of deep vein thrombosis, but the incidence oflVCS is still unclear. The purpose of this prospective study was to determine the incidence of IVCS in an asymptomatic patient population and to evaluate the risk factors in patients with and without 1VCS. Methods： From October 2011 to November 2012, a total of 500 patients （228 women and 272 men; mean age of 55.4 ± 14.7 years） with no vascular-related symptoms were enrolled in this study. Computed tomography was performed to evaluate all patients. The degree of venous compression was calculated as the diameter of the common iliac vein at the site of maximal compression divided by the mean diameter of the uncompressed proximal and caudal left common iliac vein （LCIV）. We compared the stenosis rate of the common iliac vein in women and men according to age and followed up patients to evaluate outcomes. Results： The mean compression degree of the LCIV was 16% （4%, 36%）： 37.8% of patients had a compression degree ≥25% and 9.8% had a compression degree ≥50%. There was a significant difference between men and women in the LCIV compression degree （9% [3%, 30%] vs. 24% [8%, 42%]; U = 4.66, P 〈 0.01）. In addition, the LCIV compression degree among younger women （≤40 years） was significantly different compared with that in older women （〉40 years） （42% [31%, 50%] vs. 19% [5%, 39%]; U = 5.14, P 〈 0.001 ）. Follow-up was completed in 367 patients with a mean follow-up of 39.5 months （range, 6-56 months）. The incidence of IVCS in the follow-up period was 1.6%. Stenosis rate and the diameter of the site of maximal compression correlated with the incidence of IVCS. Multivariable Cox regression analysis showed that the stenosis rate was an independent risk factor of IVCS （Wald x2 = 8.84, hazard ratio = 1.13, P 〈 0.001 ）. Conclusions： The incidence of IVCS was low and correlated with the stenosis rate ofiliac vein. Preventative therapy may be warrante展开更多
目的:探讨置管溶栓(CDT)结合髂静脉支架对Cokett综合征伴下肢深静脉血栓(DVT)患者近远期疗效。方法:将2013年1月—2015年1月收治的90例Cockett综合征伴DVT患者用随机数字表法分为观察组和对照组,每组各45例,观察组采用CDT联合支架治疗,...目的:探讨置管溶栓(CDT)结合髂静脉支架对Cokett综合征伴下肢深静脉血栓(DVT)患者近远期疗效。方法:将2013年1月—2015年1月收治的90例Cockett综合征伴DVT患者用随机数字表法分为观察组和对照组,每组各45例,观察组采用CDT联合支架治疗,对照组采用单独的CDT治疗,对比两组近远期疗效、血管损伤程度及炎症因子变化。结果:两组患者术后疗效差异无统计学意义(H=0.518,P=0.604)。所有患者随访36~40个月,无支架断裂、移位、塌陷、解体或穿破血管现象。观察组再阻塞率低于对照组(11.1% vs. 37.8%,P<0.05)、一次通畅率高于对照组(88.9% vs. 62.2%,P<0.05)。观察组末次随访Villalta评分、VCSS评分低于对照组,CIVIQ评分高于对照组(P<0.05)。两组患者术后血管损伤程度评分、血清TNF-α、IL-10水平较术前明显升高,观察组升高程度明显大于对照组(均P<0.05);观察组再阻塞患者血管损伤程度评分、血清TNF-α、IL-10水平明显高于无再阻塞患者(P<0.05),对照组再阻塞与无再阻塞患者血管损伤程度评分、血清TNF-α、IL-10水平差异无统计学意义(P>0.05)。两组不良反应率差异无统计学意义(P>0.05)。结论:CDT联合髂静脉支架植入治疗Cockett综合征伴DVT近期疗效与单独的CDT相似,但远期疗效优于单独的CDT。CDT联合支架植入治疗后发生再阻塞,可能与支架植入刺激炎症因子释放和导致血管损伤有关。展开更多
May-Thurner syndrome(MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein theright common iliac art...May-Thurner syndrome(MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein theright common iliac artery overlies and compresses the left common iliac vein against the fifth lumbar spine resulting in increased risk of iliofemoral deep venous thrombosis. This variant has been shown to be present in over 23% of the population but most go undetected. We present a patient with MTS who developed high output cardiac failure due to an iatrogenic iliac fistula. The patient underwent an extensive workup for a left to right shunt including MRI and arterial duplex in the vascular lab. He was ultimately found to have a 2.1 cm left common iliac artery aneurysm and history of common iliac stent. We took the patient to the operating room for aortogram with placement of an endovascular plug of the left internal iliac artery and aorto-biiliac stent graft placement with CO2 and Ⅳ contrast. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 mo of anticoagulation with warfarin. The flow from the fistula decreased significantly.展开更多
文摘Background： Iliac vein compression syndrome （1VCS） is an important cause of deep vein thrombosis, but the incidence oflVCS is still unclear. The purpose of this prospective study was to determine the incidence of IVCS in an asymptomatic patient population and to evaluate the risk factors in patients with and without 1VCS. Methods： From October 2011 to November 2012, a total of 500 patients （228 women and 272 men; mean age of 55.4 ± 14.7 years） with no vascular-related symptoms were enrolled in this study. Computed tomography was performed to evaluate all patients. The degree of venous compression was calculated as the diameter of the common iliac vein at the site of maximal compression divided by the mean diameter of the uncompressed proximal and caudal left common iliac vein （LCIV）. We compared the stenosis rate of the common iliac vein in women and men according to age and followed up patients to evaluate outcomes. Results： The mean compression degree of the LCIV was 16% （4%, 36%）： 37.8% of patients had a compression degree ≥25% and 9.8% had a compression degree ≥50%. There was a significant difference between men and women in the LCIV compression degree （9% [3%, 30%] vs. 24% [8%, 42%]; U = 4.66, P 〈 0.01）. In addition, the LCIV compression degree among younger women （≤40 years） was significantly different compared with that in older women （〉40 years） （42% [31%, 50%] vs. 19% [5%, 39%]; U = 5.14, P 〈 0.001 ）. Follow-up was completed in 367 patients with a mean follow-up of 39.5 months （range, 6-56 months）. The incidence of IVCS in the follow-up period was 1.6%. Stenosis rate and the diameter of the site of maximal compression correlated with the incidence of IVCS. Multivariable Cox regression analysis showed that the stenosis rate was an independent risk factor of IVCS （Wald x2 = 8.84, hazard ratio = 1.13, P 〈 0.001 ）. Conclusions： The incidence of IVCS was low and correlated with the stenosis rate ofiliac vein. Preventative therapy may be warrante
文摘目的:探讨置管溶栓(CDT)结合髂静脉支架对Cokett综合征伴下肢深静脉血栓(DVT)患者近远期疗效。方法:将2013年1月—2015年1月收治的90例Cockett综合征伴DVT患者用随机数字表法分为观察组和对照组,每组各45例,观察组采用CDT联合支架治疗,对照组采用单独的CDT治疗,对比两组近远期疗效、血管损伤程度及炎症因子变化。结果:两组患者术后疗效差异无统计学意义(H=0.518,P=0.604)。所有患者随访36~40个月,无支架断裂、移位、塌陷、解体或穿破血管现象。观察组再阻塞率低于对照组(11.1% vs. 37.8%,P<0.05)、一次通畅率高于对照组(88.9% vs. 62.2%,P<0.05)。观察组末次随访Villalta评分、VCSS评分低于对照组,CIVIQ评分高于对照组(P<0.05)。两组患者术后血管损伤程度评分、血清TNF-α、IL-10水平较术前明显升高,观察组升高程度明显大于对照组(均P<0.05);观察组再阻塞患者血管损伤程度评分、血清TNF-α、IL-10水平明显高于无再阻塞患者(P<0.05),对照组再阻塞与无再阻塞患者血管损伤程度评分、血清TNF-α、IL-10水平差异无统计学意义(P>0.05)。两组不良反应率差异无统计学意义(P>0.05)。结论:CDT联合髂静脉支架植入治疗Cockett综合征伴DVT近期疗效与单独的CDT相似,但远期疗效优于单独的CDT。CDT联合支架植入治疗后发生再阻塞,可能与支架植入刺激炎症因子释放和导致血管损伤有关。
文摘May-Thurner syndrome(MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein theright common iliac artery overlies and compresses the left common iliac vein against the fifth lumbar spine resulting in increased risk of iliofemoral deep venous thrombosis. This variant has been shown to be present in over 23% of the population but most go undetected. We present a patient with MTS who developed high output cardiac failure due to an iatrogenic iliac fistula. The patient underwent an extensive workup for a left to right shunt including MRI and arterial duplex in the vascular lab. He was ultimately found to have a 2.1 cm left common iliac artery aneurysm and history of common iliac stent. We took the patient to the operating room for aortogram with placement of an endovascular plug of the left internal iliac artery and aorto-biiliac stent graft placement with CO2 and Ⅳ contrast. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 mo of anticoagulation with warfarin. The flow from the fistula decreased significantly.
