Endovascular Treatment for Iliac Vein Compression Syndrome in 112 Cases / 中国微创外科杂志

ABSTRACT

Objective To investigate the clinical efficacy of endovascular treatment for iliac vein compression syndrome (IVCS) in 112 cases. Methods From September 2011 to June 2015, 112 cases of IVCS (Cockett syndrome) were treated in our hospital with endovascular methods .The case numbers of different CEAP ( clinical etiological anatomical pathophysical ) classifications were C2 (45 cases), C3 (23 cases), C4 (19 cases), C5 (11 cases) and C6 (14 cases).All the cases were diagnosed by venography .The operations started from puncturing the ipsilateral veins .The stenotic degree and compressed intensity of iliac vein were evaluated by the minimum diameter with low pressure balloon .And then a stent was placed into after percutaneous transluminal angioplasty ( PTA) when residual stenosis was more than 50%.The occlusive segment was dilated by 8 mm diameter balloon firstly , and catheter directed thrombolysis treatment was applied if thrombus was detected .The PTA and stenting were performed when the thrombus was completely removed .The improvement of clinical symptoms was observed after operation and the patients were followed up by ultrasound and venograghy . Results Nine cases were given PTA only , and the other 103 cases underwent stent placement . Postoperative venography showed collateral vessels were disappeared in 22 cases, obviously decreased in 56 cases and mildly decreased in 34 cases.The average difference of swelling leg ’s circle was diminished from (2.56 ±0.88) cm pre-operation to (0.93 ±0.71) cm post-operation, while the average area of skin ulcer was diminished from (6.34 ±3.78) cm2 pre-operation to (2.13 ±1.88) cm2 post-operation, all of which were statistically significant (t =20.24 and 7.19,P=0.000).A total of 86 cases were successfully followed up during a period from 2 months to 45 months (average, 19.2 months).The patency rate of treated iliac vein 12 months after operation was 76.2%in the PTA group, and in the PTA with stenting group was 96.7%, 88.6%, and 86.1%, respectively, at 12, 24, and 36 months after operation, in which a statistical significance was detected (log-rank χ2 =30.32, P=0.000).The patency rate in diameter ≥16 mm group was 95.2%and 95.2%, respectively, at 12 and 24 months after operation, while in diameter <16 mm group was 97.0%and 93.3%, respectively, in which no statistical significance was detected (log-rankχ2 =0.39, P=0.532).Thrombotic complication was found in 2 cases during the follow-up period , including 1 case of iliac vein thrombosis at 1 month and 1 case of thrombus in contralateral leg 8 months later .According to the results of venography in 78 cases at 12 months after operation , restenosis was found in 5 out of 6 cases in the PTA group, and the patency rate in the stent placement group was 95.8%(69/72).No stent migration was found . Conclusion Comfortable clinical results were obtained after endovascular therapy for iliac vein compression syndrome , and the application of stenting could increase the middle and long term patency rate of treated vessels .