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(1.Department of Radiology, the PLA 175th Hospital, the Affiliated Dongnan Hospital ofXiamen University, Zhangzhou 363000, China; 2.Department of Nursing, GulangyuConvalescent Hospital of Nanjing Military Command, Xiamen 361002, China)



Clinical pathway and impact facors for treatment of Cockett syndrome

OUYANGLin1*,ZHOUManzhen2,XUSiding1*,HEPing1,CHENShuibin1

(1.DepartmentofRadiology,thePLA175thHospital,theAffiliatedDongnanHospitalofXiamenUniversity,Zhangzhou363000,China; 2.DepartmentofNursing,GulangyuConvalescentHospitalofNanjingMilitaryCommand,Xiamen361002,China)

ObjectiveTo explore the diagnostic and therapeutic pathway of iliac vein compression syndrome (IVCS, Cockett syndrome) in clinic, and analyze potential influential factors on therapeutic efficacy. MethodsSixty-nine patients with IVCS were arranged to perform CT venography (CTV) before interventional therapy. Based-on CT anatomic diversity of the iliac vein tunnel (IVT) and compressing factors of the iliac vein, IVCS were divided into simple IVCS (sIVCS,n=22), lower lumbar degeneration-related IVCS (dIVCS,n=33) and other cause IVCS (oIVCS,n=14). Therapeutic regimen was designed as programmed stage-treatment, namely targeted intravenous catheter-directed thrombosis, intravenous mechanically thromb-broken aspiration and balloon dilatation, iliac venous stent implantation. Therapeutic efficacy was ranked as effective treatment and invalid treatment (including relapse). ALogisticregression analysis was used to evaluate the factors of affecting the therapeutic results. ResultsOnly 15 of 69 cases were effectively cured by targeted intravenous catheter-directed thrombolysis, including 10 of oIVCSs and 5 of dIVCSs. The other 54 ineffectively-treated patients were arranged to accept thromb-broken and aspiration treatment and following intravenous balloon dilatation, of whom 26 cases obtained effective treatment (6 of sIVCSs, 16 of dIVCSs, 4 of oIVCSs ). Then vessel stentings were performed in the stenotic iliac veins in 37 cases, all cases achieved satisfactory iliac vein patency without a recurring in a 12-month follow-up duration.Logisticregression analysis demonstrated that IVCS type (β=4.14,WaldtestP<0.01), course of disease (β=-5.33,WaldtestP=0.02), thromb density (β=-6.46,WaldtestP=0.01), scope of embolism (β=2.74,WaldtestP=0.03) and treatment plan (β=11.92,WaldtestP=0.01) markedly influenced the therapeutic results. ConclusionAccording to the characteristics of different types of IVCS, reasonable choice of interventional therapeutic regimen is beneficial to improve the curative effect.

Iliac vein compression syndrome; Radiography, interventional; Therapeutics; Effect factor

髂静脉压迫综合征(iliac vein compression syndrome, IVCS)为左侧髂静脉自右向左移行过程中，经过右侧髂动脉与下腰椎之间的间隙，受右侧髂动脉长期搏动性压迫而发生静脉腔内慢性血栓性病变、盆腔淤血和侧支循环形成，继而出现左下肢深静脉血栓、下肢肿痛等一系列急性临床表现[1]。放置腔静脉滤器和髂静脉血管支架并辅以靶血管内溶栓为目前公认的首选治疗方法[2]，但治疗IVCS的效果差异很大，包括髂静脉腔再通成功率和栓塞复发情况都难以令人满意[3]。本文探讨IVCS诊治路径及影响治疗效果的因素，旨在提高对IVCS术前评估的精准性以优化治疗策略。

1　资料与方法

1.1一般资料收集2009年7月—2014年6月69例IVCS患者，其中男25例，女44例，年龄24～86岁，中位年龄53岁；临床表现为左下肢肿痛1天～6周，且进行性加重。纳入标准：①临床和影像学明确诊断IVCS，性别和年龄不限；②临床和影像学(含超声、CT及DSA)资料完整；③治疗过程和随访结果可追溯。排除标准：①下肢骨折、妊娠、下肢静脉病变、腹腔或腹膜后间隙病变等非左髂静脉压迫引起的IVCS患者；②治疗过程不完整和随访不到12个月者。

根据CT显示的髂静脉压迫原因将患者分为3型：①单纯型IVCS(simple IVCS， sIVCS)，22例，男6例，女16例，单纯由髂动脉在椎体前方压迫髂静脉造成静脉病变而发生压迫综合征者。②腰椎退变相关型IVCS (lumbar degeneration-related IVCS, dIVCS)，33例，其中男12例，女21例，除髂动脉从前方压迫髂静脉，下腰椎退行性改变如椎间盘膨出或凸出、骨赘、腰椎滑脱及前纵韧带骨化等从后方嵌入性压迫髂静脉，静脉发生栓塞而出现压迫综合征者。……