ObjectiveTo investigate the clinical efficacy of AngioJet thrombectomy combined with iliac vein stenting for patients diagnosed with acute lower extremity deep venous thrombosis (DVT) with iliac vein compression syndrome（IVCS）. MethodsBetween January 2021 and October 2023, a total of 64 patients with acute lower extremity DVT which performed AngioJet thrombectomy combined with iliac vein stenting in Weifang People’s Hospital were retrospectively analyzed. The changes of clinical symptoms, signs, and thrombus burden before and after operation were observed. The patency score of vein and stent, difference of thigh circumference and calf circumference diameter, venous clinical severity score (VCSS), and chronic venous insufficienc questionnaire-14item (CIVIQ-14) score were recorded pre- and postsurgically, and the patency of stent was statistically evaluated by a comprehensive assessment of the postoperative 12-month angiography. ResultsOperative success was achieved in all the 64 patients. The aspiration time was 300–480 s [(313±32) s], and the operative time was 80–120 min [ (97±21) min]. No complications such as bleeding and hematoma occurred after operation. The hospitalization time was 5–12 d [ (7.5±2.8) d]. After operation, the patency score of vein and stent and the difference of thigh circumference diameter decreased or reduced, and the difference were statistically significant (P<0.001). The score of VCSS decreased, score of CIVIQ-14 increased after operation (P<0.05). Color Doppler ultrasound was performed at the first, third and sixth months after operation, and anterograde venography of lower limbs was performed at the 12th month. Only one patient had thrombosis recurrence at one month after operation, and finally developed into post-thrombosis syndrome of deep veins of lower limbs after anticoagulant conservative treatment. The veins and stents of the rest patients were unobstructed. ConclusionAngioJet thrombectomy combined with iliac vein stenting, could effectively expedited clot removal, reduced limb swelling, prevented post-thrombotic syndrome recurrence and significantly improved quality of life for patients with acute lower extremity DVT.
ObjectiveTo summarize strategy of diagnosis and treatment of thrombotic iliac vein stenosis in recent years.MethodThe relevant literatures in recent 5 years on the current status and trend of diagnosis and treatment of the thrombotic iliac vein stenosis were reviewed.ResultsAt present, the diagnostic methods of thrombotic iliac vein stenosis mainly included that the multi-slice spiral CT, venography, intracavitary ultrasound, magnetic resonance imaging, color Doppler ultrasound and other imaging examinations, each of which had its advantages and disadvantages. There were still no uniform criteria whether a filter should be placed, whether the stents should and how to be placed, and when to intervene in the patients with acute thrombotic iliac vein stenosis. There was no definite conclusion when and how to effectively intervene in the patients with chronic thrombotic iliac vein stenosis.ConclusionsIncidence of thrombotic iliac vein stenosis is high and sequela is severe. Early diagnosis and reasonable treatment are very important. Only strictly grasping indications, combining medical technology and patient’s condition, and adopting appropriate treatment strategy, can make patients’ maximal benefit.
ObjectiveTo compare the improvement of clinical symptoms and patency of stents in patients with left and right non-thrombotic iliac vein compression syndrome (NIVCS) after endovascular stent therapy. MethodsThe clinical data of patients with NIVCS admitted to the First Affiliated Hospital of Chongqing Medical University from January 2016 to January 2021 were analyzed retrospectively. The venous clinical severity score of the patients’ veins before therapy and on month 12 after therapy was analyzed. At the same time, the patencies of stents on month 1, 3, 6, and 12 after stenting were also analyzed. ResultsA total of 164 patients with NIVCS were collected, including 144 left NIVCS and 20 right NIVCS. The surgical technique success rate of endovascular stent therapy was 100% (164/164). There was no statistical difference of the venous clinical severity score between the patients with left and right NIVCS on month 12 after therapy (t=1.265, P=0.208), but the venous clinical severity score of left and right NIVCS patients on month 12 after therapy were lower than those before therapy (t=27.534, P<0.001; t=10.047, P<0.001). The accumulative one-stage stent patency rate on month 12 after therapy was 96.5% and 94.7% in the patients with left and right NIVCS, respectively (χ2=0.160, P=0.689). After the stent was fully supported and completely covered the extent of the lesion, the short-term (within 12 months) stent patency rates of the patients with different compression site of the iliac vein, as well as type, diameter, and length of stent placement had no statistical differences (P>0.05). ConclusionFrom the results of this study, whether left NIVCS or right NIVCS, endovascular stent therapy is safe and effective.
Objective To evaluate changes of local flow field following implantation of a designed iliac venous stent. Methods Anin vitro physical model with iliocava junction was established. A modified iliac venous stent was implanted into one side and a conventional stent into the other side. The bilateral local flow fileds following implantation of stents were measured by using particle image velocimetry. Results The results of particle image velocimetry testing revealed that the main flow orientation was shifted to the right side and the region of slowly local flow was observed after implantation of conventional iliac venous stent. However, no evident changes were noted in the local flow field and no whirling flow was detected following implantation of the designed iliac venous stent. Conclusion Conventional stent is implanted into iliac vein by using a traditional technique and stent is proximal to heart and covers opening of contralateral iliac vein, which exerts certain influence upon local flow field. Local flow field has no obvious change following implantation of a designed iliac venous stent.
On January 11, 2022, the European Society of Vascular Surgery (ESVS) completed its first update in the “European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” since 2015. Based on the existing literatures and expert consensus, the guidelines added and revised the treatment strategies, postoperative monitoring, and postoperative anticoagulation of superficial venous insufficiency of the lower extremities and pelvic venous diseases. The new and modified parts will be interpreted.
Objective To explore the feasibility of clinical application of hepatic artery （HA） or proper hepatic artery （PHA） anastomosing with superior mesenteric artery （SMA） and internal iliac vein （IIV） anastomosing with superior mesenteric vein （SMV） or portal vein （PV） in the extended pancreaticoduodenectomy combined with vascular resection．Methods The HA，PHA，SMA， SMV， PV， and IIV were dissected on 20 adult corpses， and the length， thickness，and lumen diameter of blood vessels were measured and compared with the results of multislice spiral CT scan，magnetic resonance angiography，or color Doppler in 25 patients with pancreatic head carcinoma．The extended pancreaticoduodenectomy was carried out on 5 patients of pancreatic head carcinoma with vascular invasion according to the mathcing results，and the reconstructions of HA or PHA with SMA and IIV with SMV or PV were performed．Results According to autopsy，HA-PHA was （5.50±1.50） cm in length，（0.20±0.01） mm in thickness，（5.02±1.32） mm in lumen diameter；and SMA was （4.00±1.00） cm in length，（0.21±0.01） mm in thickness，（6.05±1.06） mm in lumen diameter．The lumen diameter of left IIV，right IIV，and PV or SMV was （11.06±0.16） mm，（11.10±0.13） mm，and （11.56±0.20） mm，respectively．The thickness of left IIV，right IIV，and PV or SMV was （0.10±0.01） mm，（0.10±0.02） mm，and （0.10±0.02） mm，respectively．The multislice spiral CT scan，magnetic resonance angiography，color Doppler，and selective arteriography in vivo showed that the thickness and lumen diameter of HA-PHA and SMA were wider （0.1 mm and 0.3 mm） than those of the autopsy results，and there were no statistic significances （P＞0.05），but the length of HA-PHA was longer （1－2 cm） than that of SMA，and there was statistic significance （P＜0.05）. The survival of 5 patients with extended pancreaticoduodenectomy combined with PHA or SMA and IIV-PV/SMV resection and reconstruction was longer than that of palliative surgery patients or giving-up patients at the same period，and no long-term complications occurred．Conclusions The vascular invasion of pancreatic head carcinoma is not an absolute contraindication of radical pancreaticoduodenectomy．The survival of 5 patients with vascular invasion of pancreatic head carcinoma in this group is prolonged by extended pancreaticoduodenectomy combined with vascular resection and reconstruction as compared with palliative surgery group at the same period．HA，PHA，and IIV are the best autologous vascular alternative materials without more complications． Being familiar with regional anatomy will guide the surgeons in extended pancreaticoduodenectomy.
Venous occlusive diseases include acute deep vein thrombosis, as well as chronic iliac vein compression syndrome and post thrombotic syndrome. These diseases can lead to severe venous hypertension which greatly affect life quality. So domestic and international vascular society both have published several guidelines and consensus focusing on these diseases including the “Diagnosis and Treatment Standard about Common Venous Diseases 2022” by Vein Group of Vascular Surgery Committee from Chinese Medical Doctor Association, “2021 Clinical Practice Guidelines on the Management of Venous Thrombosis” and “2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” by European Society of Vascular Surgery. Herein, we make a comparison and explanation of these guidelines and consensus to provide reference to the management of venous occlusive diseases.
ObjectiveTo investigate the research progress of diagnosis and treatment of iliac vein compression syndrome (IVCS) so as to find the optimal diagnosis and treatment method in clinic. MethodLiterature about etiology, pathophysiology, clinical manifestations, diagnosis and treatment of IVCS in recent years was reviewed. ResultsIVCS was one of the pelvic vein obstructive diseases. The compression of left common iliac vein by right common iliac artery was more common in clinic, and it could also cause partial or complete occlusion of the iliac vein due to other external pressures. Clinical manifestations mainly included venous pain, edema, varicose veins, venous ulcer, skin pigmentation, and other skin nutritional changes. The examination methods mainly included color Doppler ultrasound, computed tomography venography, magnetic resonance venography, intravascular ultrasound, and venography. The treatment method had been changed from the original open venous reconstruction to intravascular treatment. Endovascular treatment was included thrombolysis, thrombectomy, percutaneous mechanical thrombectomy, balloon angioplasty, and endovascular stent treatment or combination treatment according to whether they were combined with iliac-femoral venous thrombosis or not. ConclusionBased on the existing researches, intravascular ultrasound is the first choice to diagnose and guide the intravascular treatment, and iliac vein stenting is an effective method for the treatment of IVCS with a good long-term patency and obvious symptom improvement.
The European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines showed us venous thrombosis management in January 2022. In terms of iliac vein diseases, it retained some guiding views, upgraded some guiding views, and added some new views compared with the version 2015. It has good guidance and reference significance for medical staff and patients. The part of the guidelines about iliac vein disease is worth our interpretation.
ObjectiveTo evaluate the efficacy and safety of intracavitary treatment for iliac vein compression syndrome（IVCS）with acute lower extremity deep venous thrombosis (DVT).MethodsThe 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.ResultsThe 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%).ConclusionStent 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.