Endovascular intervention for iliac vein compression syndrome with acute lower extremity deep vein thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CAO Wanjun ,  CHEN Quan , WEN Shiqi , LI Anqiang , DONG Fang , NIU Qibing , SHI Hao , SUN Wanli

Department of Vascular Surgery, People’s Hospital of Gansu Province, Gansu University of Chinese Medicine, Lanzhou 730000, P. R. China;

Corresponding author：

CHEN Quan, Email: 13919093907@126.com

Keywords：

endovascular intervention; iliac vein compression syndrome; acute lower extremity deep venous thrombosis

DOI：

10.7507/1007-9424.201907069

Video：

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Objective To evaluate the efficacy and safety of intracavitary treatment for iliac vein compression syndrome（IVCS）with acute lower extremity deep venous thrombosis (DVT).Methods The clinical data of 57 patients with IVCS and lower extremity DVT, who undergoing with stent implantation, balloon expansion and Angiojet rheolytic thrombectomy from June 2015 to June 2018, were retrospectively analyzed. The effect of treatment was evaluated by the changes of thigh circumference difference between the affected side and the healthy side, and the thrombosis clearance rate in the operating. In addition, the incidence of post-thrombotic syndrome (PTS) and stent patency rate were analyzed after long-term follow-up based on the change of Villaita scale score and ultrasound examination of lower extremity veins.Results The success rate of surgical technique was 100%, and there was no pulmonary embolism during operating and postoperative. Lower extremity deep vein thrombosis clearance levels Ⅲ 48 cases (84.2%), Ⅱ 9 cases (15.8%), the changes of thigh circumference difference between the affected side and the healthy side from preoperative (5.8±1.7) cm to (3.7±1.0) cm. One year follow-up after operation, the primary patency rate of stent was 86.0% and PTS occurred in 8 patients (14.0%).Conclusion Stent implantation, balloon expansion and Angiojet rheolytic thrombectomy for IVCS with acute lower extremity DVT is a safe, effective with low incidence of complications and efficient thrombus clearance.

Citation： CAO Wanjun, CHEN Quan, WEN Shiqi, LI Anqiang, DONG Fang, NIU Qibing, SHI Hao, SUN Wanli. Endovascular intervention for iliac vein compression syndrome with acute lower extremity deep vein thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(4): 429-433. doi: 10.7507/1007-9424.201907069 Copy

1.	吴霜, 顾建平, 楼文胜. 髂静脉受压综合征病因及诊疗研究进展. 介入放射学杂志, 2015, 24(8): 733-737.
2.	May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology, 1957, 8(5): 419-427.
3.	Kibbe MR, Ujiki M, Goodwin AL, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg, 2004, 39(5): 937-943.
4.	Kar S, Webel R. Septic thrombophlebitis: percutaneous mechanicalthrombectomy and thrombolytic therapies. Am J Ther, 2014, 21(2): 131-136.
5.	Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
6.	Knuttinen MG, Naidu S, Oklu R, et al. May-Thurner: diagnosis and endovascular management. Cardiovasc Diagn Ther, 2017, 7(Suppl 3): S159-S164.
7.	Raju S, Neglen P. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg, 2006, 44(1): 136-143.
8.	Metzger PB, Rossi FH, Kambara AM, et al. Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound. J Vasc Surg Venous Lymphat Disord, 2016, 4(1): 18-27.
9.	Slater S, Oswal D, Bhartia B. A retrospective study of the value of indirect CT venography: a British perspective. Br J Radiol, 2012, 85(1015): 917-920.
10.	王利伟, 顾建平, 沈莉, 等. May-Thurner 综合征的医学成像研究进展. 国际医学放射学杂志, 2015, 38(1): 46-49.
11.	Brazeau NF, Harvey HB, Pinto EG, et al. May-Thurner syndrome: diagnosis and management. Vasa, 2013, 42(2): 96-105.
12.	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. Ann Vasc Surg, 2019: S0890-5096(19)30283-3.
13.	Ignatyev IM, Pokrovsky A, Gradusov E. Long-term results of endovascular treatment of chronic iliofemoral venous obstructive lesions. Vasc Endovascular Surg, 2019, 53(5): 373-378.
14.	Neglén P. Endovascular reconstruction for chronic iliofemoral neointimal hyperplasia, and stenting of prolonged occlusive vein obstruction. // Gloviczki P, ed. Handbook of venous disorders. London: Hodder Arnold, 2009: 491-502.
15.	Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharma-comechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
16.	Kahn SR. The post-thrombotic syndrome. American Society of Hematology, 2016, 2016(1): 413-418.
17.	Berger A, Jaffe JW, York TN. Iliac compression syndrome treated with stent placement. J Vasc Surg, 1995, 21(3): 510-514.
18.	Murphy EH, Raju S. Endovascular treatment of post-thrombotic iliofemoral venous obstruction.//Gloviczki P, ed. Handbook of Venous and Lymphatic Disorders. 4th ed. Boca Raton, FL: CRC Press, 2017: 533-539.
19.	毛由军, 李承龙, 雷锋锐, 等. AngioJet 机械性血栓抽吸系统联合 CDT 治疗急性下肢深静脉血栓的疗效分析. 中华医学杂志, 2017, 97(34): 2687-2690.
20.	Liu J, Liu P, Xia K, et al. Iliac vein compression syndrome (IVCS): an under-recognized risk factor for left-sided deep venous thrombosis (DVT) in old hip fracture patients. Med Sci Monit, 2017, 23: 2078-2082.
21.	Liu G, Qin J, Cui C, et al. Comparison of direct iliofemoral stenting following AngioJet rheolytic thrombectomy vs staged stenting after AngioJet rheolytic thrombectomy plus catheter-directed thrombolysis in patients with acute deep vein thrombosis. J Endovasc Ther, 2018, 25(1): 133-139.
22.	Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL (peripheral use of AngioJet rheolytic thrombectomy with a variety of catheter lengths) registry. J Vasc Interv Radiol, 2015, 26(6): 777-785, 786.
23.	De Graaf R. Management and treatment of occluded large veins. Endovascular management.// Bækgaard N, Fanelli F, O’Sullivan GJ, eds. New Horizons in Deep Venous Disease Management. Turin, Italy: Edizioni Minerva Medica, 2017: 160-171.
24.	Pokrovsky A, Ignatyev I, Gradusov E. First experience of performing hybrid operations in chronic venous obstructions of iliofemoral segments in patients with postthrombotic syndrome. Vasc Endovasc Surg, 2017, 5(7): 447-452.

1. 吴霜, 顾建平, 楼文胜. 髂静脉受压综合征病因及诊疗研究进展. 介入放射学杂志, 2015, 24(8): 733-737.
2. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology, 1957, 8(5): 419-427.
3. Kibbe MR, Ujiki M, Goodwin AL, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg, 2004, 39(5): 937-943.
4. Kar S, Webel R. Septic thrombophlebitis: percutaneous mechanicalthrombectomy and thrombolytic therapies. Am J Ther, 2014, 21(2): 131-136.
5. Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
6. Knuttinen MG, Naidu S, Oklu R, et al. May-Thurner: diagnosis and endovascular management. Cardiovasc Diagn Ther, 2017, 7(Suppl 3): S159-S164.
7. Raju S, Neglen P. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg, 2006, 44(1): 136-143.
8. Metzger PB, Rossi FH, Kambara AM, et al. Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound. J Vasc Surg Venous Lymphat Disord, 2016, 4(1): 18-27.
9. Slater S, Oswal D, Bhartia B. A retrospective study of the value of indirect CT venography: a British perspective. Br J Radiol, 2012, 85(1015): 917-920.
10. 王利伟, 顾建平, 沈莉, 等. May-Thurner 综合征的医学成像研究进展. 国际医学放射学杂志, 2015, 38(1): 46-49.
11. Brazeau NF, Harvey HB, Pinto EG, et al. May-Thurner syndrome: diagnosis and management. Vasa, 2013, 42(2): 96-105.
12. 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. Ann Vasc Surg, 2019: S0890-5096(19)30283-3.
13. Ignatyev IM, Pokrovsky A, Gradusov E. Long-term results of endovascular treatment of chronic iliofemoral venous obstructive lesions. Vasc Endovascular Surg, 2019, 53(5): 373-378.
14. Neglén P. Endovascular reconstruction for chronic iliofemoral neointimal hyperplasia, and stenting of prolonged occlusive vein obstruction. // Gloviczki P, ed. Handbook of venous disorders. London: Hodder Arnold, 2009: 491-502.
15. Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharma-comechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
16. Kahn SR. The post-thrombotic syndrome. American Society of Hematology, 2016, 2016(1): 413-418.
17. Berger A, Jaffe JW, York TN. Iliac compression syndrome treated with stent placement. J Vasc Surg, 1995, 21(3): 510-514.
18. Murphy EH, Raju S. Endovascular treatment of post-thrombotic iliofemoral venous obstruction.//Gloviczki P, ed. Handbook of Venous and Lymphatic Disorders. 4th ed. Boca Raton, FL: CRC Press, 2017: 533-539.
19. 毛由军, 李承龙, 雷锋锐, 等. AngioJet 机械性血栓抽吸系统联合 CDT 治疗急性下肢深静脉血栓的疗效分析. 中华医学杂志, 2017, 97(34): 2687-2690.
20. Liu J, Liu P, Xia K, et al. Iliac vein compression syndrome (IVCS): an under-recognized risk factor for left-sided deep venous thrombosis (DVT) in old hip fracture patients. Med Sci Monit, 2017, 23: 2078-2082.
21. Liu G, Qin J, Cui C, et al. Comparison of direct iliofemoral stenting following AngioJet rheolytic thrombectomy vs staged stenting after AngioJet rheolytic thrombectomy plus catheter-directed thrombolysis in patients with acute deep vein thrombosis. J Endovasc Ther, 2018, 25(1): 133-139.
22. Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL (peripheral use of AngioJet rheolytic thrombectomy with a variety of catheter lengths) registry. J Vasc Interv Radiol, 2015, 26(6): 777-785, 786.
23. De Graaf R. Management and treatment of occluded large veins. Endovascular management.// Bækgaard N, Fanelli F, O’Sullivan GJ, eds. New Horizons in Deep Venous Disease Management. Turin, Italy: Edizioni Minerva Medica, 2017: 160-171.
24. Pokrovsky A, Ignatyev I, Gradusov E. First experience of performing hybrid operations in chronic venous obstructions of iliofemoral segments in patients with postthrombotic syndrome. Vasc Endovasc Surg, 2017, 5(7): 447-452.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Endovascular intervention for iliac vein compression syndrome with acute lower extremity deep vein thrombosis

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