Clinical Study Of Iliac Vein Compressioon Syndrome With Endovascular Treatment

ObjectiveTo investigate the treatment outcomes in patients with iliac vein compression syndrome (IVCS), who had respectively undergone endovascular treatment and conservative treatment.Materials and MethodsRetrospective study 129 IVCS patients from January 2007 to December 2009, and divided them into 3 parts:50 cases for PTA (percutaneous transluminal angioplasty) include 21 males and 29 females, and the age ranged from 25-71 years old,and the average age is 50.7 years old; 41 cases for PTA and stent include 18 males and 23 females, and the age ranged from 22-67 years old, and the average age is 48.1 years old; 38 cases for conservative treatment include 18 males and 20 females,and the age ranged from 31-75 years old, and the average age is 55.6 years old. All cases (129 cases) were injected contrast agent via dorsal vein of foot to do deep venous anterograde.26 patients with antegrade angiography showed left iliac vein was found unclear and added the left iliac vein catheterization angiography to make the lesions clear. B ultrasound and CT examination for pelvic were added in 21 patients, all patients found no pelvic tumor lesions.50 cases underwent PTA (ballon diamate ranged from 8-20mm), taking warfain orally for 3 months and adjust dosage according to the INR(Requested an extension between 1.5 to 2.5 times to the normal value); 41 cases for PTA+Stent and 19 cases were planted Z-shaped stent made in china, the left 22 cases were planted Wallstent net-shaped peripheral vessel stent and taking warfain orally for 12 months and adjust dosage according to the INR(Requested an extension between 1.5 to 2.5 times to the normal value); 38 cases for conservative treatment, wore elastic stockings and done functional exercise, took aspirin, and the Aescuven forte (European horse chestnut seed extract). The combined deep venous insufficiency and varicose veins were underwent second surgery. All patients were followed up to observe the healing effect.ResultsThere was no operative mortality.50 cases in PTA group were cured ulcers by anti-inflammatory and dressing; skin pigmentation in 14 cases disappeared and 4 had significantly decreased; chronic left lower limb swelling in 41 patients disappeared, there was still slight swelling in 4 cases.41 cases in PTA+Stent group were cured ulcers by anti-inflammatory and dressing; skin pigmentation in 15 cases disappeared and 2 had significantly decreased; chronic left lower limb swelling in 34 patients disappeared, there was still slight swelling in 3 cases. Iliac vein wall of 1 case was penetrated during the procedure of plant Z-shaped stent and caused local hematoma. After expectant treatment the patient got better. Post-stenting angiography saw restoration of iliac vein lesions and stent sprung well in place. Patient were followed up by doppler ultrasound and angiographic and no complications happens such as displacement,fracture and thrombosis.38 cases in expectant treatment group got limb swelling, soreness discomfort, and heaviness only mild improvement, Skin pigmentation, eczema, and varicose veins were not improved and 1 patient in bed due to fracture of lower extremity got deep vein thrombosis. All cases were follows up for 3-36 months and the average is 12.4 month. Analyzing the limb swelling,symptoms (including dull pain, soreness, swelling pain, skin discomfort, heaviness and muscle cramps, etc.) and varicose veins situation we can find out that treatment in PTA group and PTA+Stent group was significant than the conservative treatment group (statistically significant, P <0.01).After treatment for 3 months,6 months and 12 months,compared PTA Stent group and the conservative treatment group, the iliac vein stenosis in the former group were significantly lower than the later group (P<0.01);After 3 months of treatment, PTA groups and PTA+Stent group had no statistical significance (P> 0.05);After the treatment of 6 months and 12 months, PTA+Stent's improvement in restenosis of iliac vein was better than PTA group (P<0.01).This outcome showed that in the iliac vein restenosis incidence PTA+Stent is better than PTA and expectant treatment.ConclusionIVCS was treated by endovascular intervention has good short-term, medium-term effects. This method has the advantages of small trauma, simple operation, safe and effective with few complications, and is the preferred method of treatment for IVCS. Intervention is better than conservative therapy in short term and angioplasty plus stent placement would be less than mere balloon angioplasty in iliac vein restenosis.