The effect of stent placement for May-Thurner syndrome combined with symptomatic superficial venous reflux disease
The effect of stent placement for May-Thurner syndrome combined with symptomatic superficial venous reflux disease
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支架置入术治疗May-Thurner综合征合并症状性浅静脉反流病的效果
DOI：
10.1016/j.jvsv.2014.11.006
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发表时间：
2015-04-01
影响因子：
3.2
通讯作者：
Jiang, Mier
中科院分区：
文献类型：
--
作者：
Yin, Minyi;Huang, Xintian;Jiang, Mier
目的：本研究旨在确定合并症状性MTS/S-VRD的肢体May-Thurner综合征（MTS）与浅静脉反流病（S-VRD）是否有必要同时进行纠正。方法：回顾性分析2001年1月至2010年12月在同一医院进行的S-VRD合并MTS患者。对VRD患者行多普勒超声及静脉造影检查。对有严重症状或静脉造影提示MTS的患者选择性地进行计算机断层血管造影或经股静脉造影，发现MTS的患者有207例。其中支架置入术联合静脉内激光消融（EVLA）成功治疗121例；其余86例患者单独接受EVLA治疗S-VRD，作为对照组。观察治疗前后的临床结果、静脉返流及生活质量。多普勒超声随访支架通畅情况。结果：两组患者在年龄、男女比例、临床症状、合并症、S-VRD发生率等方面无显著差异。EVLA +支架组121例患者共植入125个支架。技术成功率为100%。随访时间1 ~ 91个月（平均70.4 ~ 21.3个月）。4年原发性通畅率为93.3%。支架+ EVLA组疼痛、水肿、溃疡发生率明显降低。然而，单独使用evla组的S-VRD复发率很高。EVLA +支架组患者生活质量明显改善；改善包括减轻疼痛、水肿、疲劳和增加体力活动。对于深静脉反流，支架置入术后MTS无明显改善。结论：支架置入术是治疗MTS合并症状性S-VRD有效且持久的方法；它的结果是高水平的长期通畅和显著缓解疼痛，水肿和溃疡。此外，MTS矫正对降低EVLA后S-VRD复发率也有重要作用。
Objective: The current study aimed to determine whether it is necessary to correct May-Thurner syndrome (MTS) simultaneously with superficial venous reflux disease (S-VRD) in limbs of combined symptomatic MTS/S-VRD.Methods: A retrospective analysis of patients with S-VRD combined with MTS was conducted in a single institution from January 2001 to December 2010. Doppler ultrasound and phlebography were performed in patients with VRD. Computed tomography angiography or transfemoral venography was selectively performed in patients with severe symptoms or findings on phlebography suggestive of MTS. MTS was found in 207 patients. Among these, 121 patients were successfully treated with stent placement combined with endovenous laser ablation (EVLA); the remaining 86 patients, who were treated with EVLA for S-VRD alone, served as a control group. Clinical results, venous reflux, and quality of life were evaluated before and after treatment. Stent patency was followed up with Doppler ultrasound.Results: There was no significant difference in age, female to male ratio, clinical symptoms, comorbidities, or percentage with S-VRD between the two groups. A total of 125 stents were placed in 121 patients in the EVLA + stent group. The rate of technical success was 100%. Follow-up periods ranged from 1 to 91 months (mean, 70.4 21.3 months). The 4 -year primary patency rate was 93.3%. The incidence of pain, edema, and ulceration was decreased significantly in the stent + EVLA group. However, there was a high rate of S-VRD recurrence in the EVLA-alone group. Quality of life improved significantly in the EVLA + stent group; improvements induded relief of pain, edema, and fatigue and increased physical activity. For deep venous reflux, there was no significant improvement after stent placement for MTS.Conclusions: Stent placement is an effective and durable treatment of MTS combined with symptomatic S-VRD; it results in a high level of long-term patency and a significant relief of pain, edema, and ulceration. Furthermore, correction of MTS plays an important role in decreasing the recurrence rate of S-VRD after EVLA.