Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis: Early and late results

被引:79
作者
Kwak, HS
Han, YM
Lee, YS
Jin, GY
Chung, GH
机构
[1] Chonbuk Natl Univ, Sch Med, Dept Radiol, Chonju 560182, South Korea
[2] Chonbuk Natl Univ, Sch Med, Cardiovasc Res Inst, Chonju 560182, South Korea
关键词
D O I
10.1097/01.RVI.0000157690.91690.38
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
PURPOSE: To evaluate, by imaging and clinical follow-up, the effectiveness and long-term results of stent placement in cases of common iliac vein obstruction associated with ipsilateral deep vein thrombosis (DVT). MATERIALS AND METHODS: Retrospective analysis of 22 patients (13 women, nine men; median age, 58 years) with common iliac vein obstruction with ipsilateral DVT was performed for this study. All patients presented with leg edema or pain and were treated with catheter-directed thrombolysis (1,000-2,000 U urokinase per kg body weight per hour; n = 19), aspiration thrombectomy (n = 21), or angioplasty (n = 14) followed by stent placement (n = 22) via an ipsilateral popliteal vein approach (right, n = 2; left, n = 20) under ultrasonographic (US) guidance. Patients were then followed by duplex US, and patency rates were determined by Kaplan-Meier survival analysis. RESULTS: The mean procedure time was 15 hours (range, 1-23 hours) and the mean urokinase dose was 1,980,000 U (range, 600,000-3,600,000 U) before the implantation of 27 stents. Three patients did not receive urokinase. The technical success rate was 96% (26 of 27 stents) and the clinical success rate was 95% (21 of 22 patients). The causes of common iliac vein obstruction were May-Thurner syndrome (n = 16), pelvic mass (n = 2), and unknown (n = 4). The early complications included upward stent migration in one patient and a spinal epidural hematoma in another. The late complication was partial stent obstruction, which was successfully treated by thrombolysis and angioplasty in one patient. Follow-up lasted 1-41 months (mean, 21.4 months). Overall, the 1-year and 2-year primary patency rates were both 95% and the 1-year and 2-year secondary patency rates were both 100%. CONCLUSION: Directed catheter thrombolysis and aspiration of DVT are relatively safe, and the use of stents improves patency results in cases of common iliac vein obstruction.
引用
收藏
页码:815 / 822
页数:8
相关论文
共 28 条
[1]   Iliofemoral deep vein thrombosis: Conventional therapy versus lysis and percutaneous transluminal angioplasty and stenting [J].
AbuRahma, AF ;
Perkins, SE ;
Wulu, JT ;
Ng, HK .
ANNALS OF SURGERY, 2001, 233 (06) :752-760
[2]  
Akesson H, 1990, Eur J Vasc Surg, V4, P43, DOI 10.1016/S0950-821X(05)80037-4
[3]   Acute iliofemoral deep vein thrombosis: Evaluation of underlying anatomic abnormalities by spiral CT venography [J].
Chung, JW ;
Yoon, CJ ;
Jung, SI ;
Kim, HC ;
Lee, W ;
Kim, YI ;
Jae, HJ ;
Park, JH .
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 2004, 15 (03) :249-256
[4]   A STRATEGY OF AGGRESSIVE REGIONAL THERAPY FOR ACUTE ILIOFEMORAL VENOUS THROMBOSIS WITH CONTEMPORARY VENOUS THROMBECTOMY OR CATHETER-DIRECTED THROMBOLYSIS [J].
COMEROTA, AJ ;
ALDRIDGE, SC ;
COHEN, G ;
BALL, DS ;
PLISKIN, M ;
WHITE, JV .
JOURNAL OF VASCULAR SURGERY, 1994, 20 (02) :244-254
[5]   SPONTANEOUS SPINAL EPIDURAL HAEMORRHAGE DURING ANTICOAGULANT THERAPY [J].
JACOBSON, I ;
MACCABE, JJ ;
HARRIS, P ;
DOTT, NM .
BMJ-BRITISH MEDICAL JOURNAL, 1966, 1 (5486) :522-+
[6]   Percutaneous AngioJet thrombectomy in the management of extensive deep venous thrombosis [J].
Kasirajan, K ;
Gray, B ;
Ouriel, K .
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 2001, 12 (02) :179-185
[7]   PROPAGATION OF DEEP VENOUS THROMBOSIS IDENTIFIED BY DUPLEX ULTRASONOGRAPHY [J].
KRUPSKI, WC ;
BASS, A ;
DILLEY, RB ;
BERNSTEIN, EF ;
OTIS, SM .
JOURNAL OF VASCULAR SURGERY, 1990, 12 (04) :467-475
[8]  
MARKEL A, 1992, ARCH SURG-CHICAGO, V127, P305
[9]   VALVULAR REFLUX AFTER DEEP-VEIN THROMBOSIS - INCIDENCE AND TIME OF OCCURRENCE [J].
MARKEL, A ;
MANZO, RA ;
BERGELIN, RO ;
STRANDNESS, DE .
JOURNAL OF VASCULAR SURGERY, 1992, 15 (02) :377-384
[10]   NONTRAUMATIC SPINAL EPIDURAL AND SUBDURAL HEMATOMAS [J].
MATTLE, H ;
SIEB, JP ;
ROHNER, M ;
MUMENTHALER, M .
NEUROLOGY, 1987, 37 (08) :1351-1356