Mid-to-long-term outcomes of catheter-directed thrombolysis in combination with percutaneous mechanical thrombectomy and stent placement treatment for acute proximal deep vein thrombosis with iliac vein compression syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Xinqian , LI Fenghe ,  FAN Gaoxiang

Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

FAN Gaoxiang, Email: fangaoxiang.2005@163.com

Keywords：

catheter-directed thrombolysis; percutaneous mechanical thrombectomy; deep vein thrombosis; iliac vein compression syndrome; post-thrombotic syndrome; restenosis

DOI：

10.7507/1007-9424.202501095

Video：

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Objective To evaluate the safety and mid-to-long-term outcomes of catheter-directed thrombolysis (CDT) in combination with percutaneous mechanical thrombectomy (PMT) followed by stent placement treatment for acute proximal deep vein thrombosis (DVT) complicated by iliac vein compression syndrome (IVCS), and to identify risk factors associated with primary stent restenosis. Methods A retrospective study was conducted. The patients diagnosed with acute proximal DVT and concurrent IVCS who underwent CDT in combination with PMT followed by stent placement at the First Affiliated Hospital of Chongqing Medical University from January 2018 to December 2021 were included. The demographics, clinical history, and procedural data were collected retrospectively. The postoperative follow-up assessments using color Doppler ultrasound were performed at 3, 6, and 12 months, and annually thereafter. The primary and secondary stent patency rates were evaluated. The univariate and multivariate Cox proportional hazards regression models were employed to assess risk factors for primary stent restenosis. Results A total of 188 patients who met the inclusion and exclusion criteria were enrolled, underwent CDT combined with PMT and stent implantation, and completed follow-up. During the follow-up, the restenosis occurred in 26 patients. The cumulative primary patency rates at 3, 6, 12, 24, 36, and 48 months after surgery were 100%, 98.9%, 92.5%, 88.3%, 86.7%, and 86.2%, respectively. The multivariate Cox proportional hazards regression analysis confirmed that a history of previous DVT [β=1.44, HR (95%CI)=4.21 (1.73, 10.28), P=0.002], implantation of two or more stents [β=2.47, HR (95%CI)=11.85 (1.66, 84.63), P=0.014], stent crossing the inguinal ligament [β=2.30, HR (95%CI)=9.92 (1.87, 52.78), P=0.007], and stent length [β=–0.02, HR (95%CI)=0.98 (0.97, 0.99), P=0.003] were independent risk factors for primary restenosis. Conclusions The findings of this study suggest that CDT combined with PMT and stent implantation is a safe and effective strategy for treating acute proximal DVT complicated by IVCS. Close attention should be paid to the occurrence of restenosis in patients with two or more stents, longer stent lengths, stents crossing the inguinal ligament, and a history of previous DVT.

1.	黄其俊, 张岩, 朱国献. 静脉血栓栓塞症国内外指南解读. 广东医学, 2022, 43(3): 285-288.
2.	Perkins JM, Magee TR, Galland RB. Phlegmasia caerulea dolens and venous gangrene. Br J Surg, 1996, 83(1): 19-23.
3.	Kahn SR. The post-thrombotic syndrome. Hematology Am Soc Hematol Educ Program, 2016, 2016(1): 413-418.
4.	Cavalcante LP, dos Santos Souza JE, Pereira RM, et al. Iliac vein compression syndrome: literature review. J Vasc Bras, 2015, 14(1): 78-83.
5.	利峰, 杨孔武, 穆茂媛, 等. 介入综合治疗Cockett综合征伴急性左下肢深静脉血栓形成. 介入放射学杂志, 2021, 30(2): 181-185.
6.	Meissner MH, Gloviczki P, Comerota AJ, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2012, 55(5): 1449-1462.
7.	Vedantham S, Grassi CJ, Ferral H, et al. Reporting standards for endovascular treatment of lower extremity deep vein thrombosis. J Vasc Interv Radiol, 2009, 20(7 Suppl): S391-S408. doi: 10.1016/j.jvir.2009.04.034.
8.	Comerota AJ, Kearon C, Gu CS, et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation, 2019, 139(9): 1162-1173.
9.	Gautier G, Douane F, David A, et al. Pharmaco-mechanical catheter-directed thrombolysis versus recanalization and stenting for post thrombotic syndrome after lower limb deep vein thrombosis: a comparative study. Quant Imaging Med Surg, 2022, 12(3): 1664-1673.
10.	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 Vasc Surg Venous Lymphat Disord, 2020, 8(1): 24-30.
11.	Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
12.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 2016, 149(2): 315-352.
13.	陈樱红, 李晓阳, 陆炜. 下腔静脉滤器在髂股静脉血栓介入治疗中的应用价值研究. 浙江医学, 2024, 46(5): 528-532.
14.	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 Vasc Surg Venous Lymphat Disord, 2023, 11(2): 339-345.
15.	卢文文, 黄碧红, 袁立, 等. 自体动静脉内瘘初次通畅时间生存分析和影响因素的前瞻性研究. 复旦学报(医学版), 2023, 50(2): 249-254.
16.	李晓强, 张福先, 王深明. 深静脉血栓形成的诊断和治疗指南(第三版). 中国血管外科杂志(电子版), 2017, 9(4): 250-257.
17.	连利珊, 冯海, 朱仁明, 等. 髂静脉压迫综合征合并急性髂股静脉血栓患者的临床分析. 中华医学杂志, 2019, 99(13): 1034-1036.
18.	Harbin MM, Lutsey PL. May-Thurner syndrome: History of understanding and need for defining population prevalence. J Thromb Haemost, 2020, 18(3): 534-542.
19.	程章波, 丁杭, 黄烽, 等. 单纯导管接触性溶栓与联合药物机械碎栓治疗急性下肢深静脉血栓的对照研究. 血管与腔内血管外科杂志, 2018, 4(03): 197-200,227.
20.	于洪波, 初仁珠, 赵冬梅, 等. 药物-机械联合血栓袪除术与导管接触性溶栓术在治疗急性下肢深静脉血栓形成中的作用对比. 世界最新医学信息文摘, 2017, 17(21): 13-14.
21.	Fraser DG, Moody AR, Martel A, et al. Re-evaluation of iliac compression syndrome using magnetic resonance imaging in patients with acute deep venous thromboses. J Vasc Surg, 2004, 40(4): 604-611.
22.	Murphy EH, Davis CM, Journeycake JM, et al. Symptomatic ileofemoral DVT after onset of oral contraceptive use in women with previously undiagnosed May-Thurner Syndrome. J Vasc Surg, 2009, 49(3): 697-703.
23.	Oguzkurt L, Ozkan U, Ulusan S, et al. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol, 2008, 19(3): 366-370.
24.	刘长青, 李嘉欣, 崔世超, 等. 早期减容对左髂静脉压迫综合征伴急性髂静脉血栓的治疗效果. 血管与腔内血管外科杂志, 2024, 10(2): 143-147,169.
25.	Shi WY, Gu JP, Liu CJ, et al. Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis: A retrospective study on mid-term in-stent patency from a single center. Eur J Radiol, 2016, 85(1): 7-14.
26.	Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med, 2017, 377(23): 2240-2252.
27.	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(第2版). 介入放射学杂志, 2019, 28(1): 1-10.
28.	Neglén P, Raju S. In-stent recurrent stenosis in stents placed in the lower extremity venous outflow tract. J Vasc Surg, 2004, 39(1): 181-187.
29.	Wasser K, Schnaudigel S, Wohlfahrt J, et al. Inflammation and in-stent restenosis: the role of serum markers and stent characteristics in carotid artery stenting. PLoS One, 2011, 6(7): e22683. doi: 10.1371/journal.pone.0022683.
30.	Aurshina A, Ascher E, Haggerty J, et al. Etiology of iliocaval stent thrombosis. J Vasc Surg Venous Lymphat Disord, 2020, 8(2): 207-210.
31.	Aday AW, Beckman JA. The open vein hypothesis and postthrombotic syndrome: Not dead yet. Circulation, 2021, 143(12): 1239-1241.

1. 黄其俊, 张岩, 朱国献. 静脉血栓栓塞症国内外指南解读. 广东医学, 2022, 43(3): 285-288.
2. Perkins JM, Magee TR, Galland RB. Phlegmasia caerulea dolens and venous gangrene. Br J Surg, 1996, 83(1): 19-23.
3. Kahn SR. The post-thrombotic syndrome. Hematology Am Soc Hematol Educ Program, 2016, 2016(1): 413-418.
4. Cavalcante LP, dos Santos Souza JE, Pereira RM, et al. Iliac vein compression syndrome: literature review. J Vasc Bras, 2015, 14(1): 78-83.
5. 利峰, 杨孔武, 穆茂媛, 等. 介入综合治疗Cockett综合征伴急性左下肢深静脉血栓形成. 介入放射学杂志, 2021, 30(2): 181-185.
6. Meissner MH, Gloviczki P, Comerota AJ, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2012, 55(5): 1449-1462.
7. Vedantham S, Grassi CJ, Ferral H, et al. Reporting standards for endovascular treatment of lower extremity deep vein thrombosis. J Vasc Interv Radiol, 2009, 20(7 Suppl): S391-S408. doi: 10.1016/j.jvir.2009.04.034.
8. Comerota AJ, Kearon C, Gu CS, et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation, 2019, 139(9): 1162-1173.
9. Gautier G, Douane F, David A, et al. Pharmaco-mechanical catheter-directed thrombolysis versus recanalization and stenting for post thrombotic syndrome after lower limb deep vein thrombosis: a comparative study. Quant Imaging Med Surg, 2022, 12(3): 1664-1673.
10. 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 Vasc Surg Venous Lymphat Disord, 2020, 8(1): 24-30.
11. Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
12. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 2016, 149(2): 315-352.
13. 陈樱红, 李晓阳, 陆炜. 下腔静脉滤器在髂股静脉血栓介入治疗中的应用价值研究. 浙江医学, 2024, 46(5): 528-532.
14. 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 Vasc Surg Venous Lymphat Disord, 2023, 11(2): 339-345.
15. 卢文文, 黄碧红, 袁立, 等. 自体动静脉内瘘初次通畅时间生存分析和影响因素的前瞻性研究. 复旦学报(医学版), 2023, 50(2): 249-254.
16. 李晓强, 张福先, 王深明. 深静脉血栓形成的诊断和治疗指南(第三版). 中国血管外科杂志(电子版), 2017, 9(4): 250-257.
17. 连利珊, 冯海, 朱仁明, 等. 髂静脉压迫综合征合并急性髂股静脉血栓患者的临床分析. 中华医学杂志, 2019, 99(13): 1034-1036.
18. Harbin MM, Lutsey PL. May-Thurner syndrome: History of understanding and need for defining population prevalence. J Thromb Haemost, 2020, 18(3): 534-542.
19. 程章波, 丁杭, 黄烽, 等. 单纯导管接触性溶栓与联合药物机械碎栓治疗急性下肢深静脉血栓的对照研究. 血管与腔内血管外科杂志, 2018, 4(03): 197-200,227.
20. 于洪波, 初仁珠, 赵冬梅, 等. 药物-机械联合血栓袪除术与导管接触性溶栓术在治疗急性下肢深静脉血栓形成中的作用对比. 世界最新医学信息文摘, 2017, 17(21): 13-14.
21. Fraser DG, Moody AR, Martel A, et al. Re-evaluation of iliac compression syndrome using magnetic resonance imaging in patients with acute deep venous thromboses. J Vasc Surg, 2004, 40(4): 604-611.
22. Murphy EH, Davis CM, Journeycake JM, et al. Symptomatic ileofemoral DVT after onset of oral contraceptive use in women with previously undiagnosed May-Thurner Syndrome. J Vasc Surg, 2009, 49(3): 697-703.
23. Oguzkurt L, Ozkan U, Ulusan S, et al. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol, 2008, 19(3): 366-370.
24. 刘长青, 李嘉欣, 崔世超, 等. 早期减容对左髂静脉压迫综合征伴急性髂静脉血栓的治疗效果. 血管与腔内血管外科杂志, 2024, 10(2): 143-147,169.
25. Shi WY, Gu JP, Liu CJ, et al. Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis: A retrospective study on mid-term in-stent patency from a single center. Eur J Radiol, 2016, 85(1): 7-14.
26. Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med, 2017, 377(23): 2240-2252.
27. 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(第2版). 介入放射学杂志, 2019, 28(1): 1-10.
28. Neglén P, Raju S. In-stent recurrent stenosis in stents placed in the lower extremity venous outflow tract. J Vasc Surg, 2004, 39(1): 181-187.
29. Wasser K, Schnaudigel S, Wohlfahrt J, et al. Inflammation and in-stent restenosis: the role of serum markers and stent characteristics in carotid artery stenting. PLoS One, 2011, 6(7): e22683. doi: 10.1371/journal.pone.0022683.
30. Aurshina A, Ascher E, Haggerty J, et al. Etiology of iliocaval stent thrombosis. J Vasc Surg Venous Lymphat Disord, 2020, 8(2): 207-210.
31. Aday AW, Beckman JA. The open vein hypothesis and postthrombotic syndrome: Not dead yet. Circulation, 2021, 143(12): 1239-1241.

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Latest ArticlesMid-to-long-term outcomes of catheter-directed thrombolysis in combination with percutaneous mechanical thrombectomy and stent placement treatment for acute proximal deep vein thrombosis with iliac vein compression syndrome

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