原发性肝下下腔静脉长段闭塞介入治疗的效果分析

doi:10.11958/20260148

摘要/Abstract

摘要：

目的探讨原发性肝下下腔静脉（IIVC）长段闭塞的介入治疗效果。方法回顾性分析28例原发性IIVC长段闭塞患者的临床资料，其中11例合并下腔静脉或髂静脉血栓形成。患者均经数字减影血管造影（DSA）明确病变范围并接受介入治疗。比较治疗前后下腔静脉远心端与近心端压差、静脉临床严重程度评分（VCSS）及临床-病因-解剖-病理生理学（CEAP）分级变化。结果所有患者均成功完成介入治疗，下腔静脉全部开通，24例行单纯球囊扩张，4例行支架植入，其中11例合并血栓形成患者先溶栓再行血管成形术，均无严重并发症。术后下腔静脉远心端与近心端压差较术前明显下降（P<0.01），术后1个月时CEAP分级和VCSS评分总体较术前改善（均P<0.01）。术后随访期间19例患者下腔静脉通畅，9例患者出现再狭窄，经二次介入治疗均成功开通。结论介入治疗原发性IIVC长段闭塞安全、有效，可显著改善患者下肢静脉症状，为临床微创治疗方案提供依据。

关键词: 腔静脉, 下, 放射学, 介入性, 静脉血栓形成, 闭塞

Abstract:

Objective To evaluate the efficacy of interventional treatment of primary long-segment infrahepatic inferior vena cava (IIVC) occlusion. Methods The clinical data of 28 patients with primary long-segment IIVC occlusion were retrospectively analyzed, including 11 patients complicated with inferior vena cava or iliac vein thrombosis. All patients underwent digital subtraction angiography (DSA) to determine the extent of the lesion and subsequently received interventional treatment. Changes in the distal-to-proximal pressure gradient across the inferior vena cava, the venous clinical severity score (VCSS) and the clinical-etiology-anatomy-pathophysiology (CEAP) classification were compared before and after treatment. Results Interventional treatment was successfully completed in all patients, and recanalization of the inferior vena cava was achieved in every case. Balloon dilation alone was performed in 24 patients, and stent implantation was performed in 4 patients. Among the 11 patients with thrombosis, catheter-directed thrombolysis was performed before angioplasty, and no severe complications occurred. The distal-to-proximal pressure gradient across the inferior vena cava decreased significantly after treatment (P<0.01). One month after the procedure, both the CEAP classification and VCSS score were generally improved compared with those before treatment (both P<0.01). During follow-up, 19 patients maintained patency of the inferior vena cava, whereas 9 developed restenosis, all were successfully recanalized by repeat interventional treatment. Conclusion Interventional treatment for primary long-segment IIVC occlusion is safe and effective, and can significantly improve lower-extremity venous symptoms, providing evidence for minimally invasive treatment strategies in clinical practice.

Key words: vena cava, inferior, radiology, interventional, venous thrombosis, occlusion

中图分类号:

R654.3

图/表 2

图1 原发性IIVC长段闭塞患者介入治疗术中影像 A、B：术中造影影像，显示肝下肾静脉上段下腔静脉闭塞；C、D：采用直径10 mm球囊扩张下腔静脉；E：球囊扩张后下腔静脉开通，可见侧支血管；F：置入Wallstent支架（直径16 mm，长60 mm）后下腔静脉血流通畅。

Fig.1 Interventional images of a patient with primary long-segment IIVC occlusion

表1 入组患者术前、术后1个月CEAP分级比较

Tab.1 Comparison of CEAP classification in enrolled patients before treatment and 1 month after treatment [n=28，例（%）]

时期	CEAP分级
时期	C0	C1	C2	C3	C4	C5	C6
术前	0（0.0）	3（10.7）	7（25.0）	4（14.3）	5（17.9）	2（7.1）	7（25.0）
术后1个月	7（25.0）	7（25.0）	3（10.7）	0（0.0）	2（7.1）	4（14.3）	5（17.9）
Z	3.724^＊＊

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