Study The Efficacy Between Mere Balloon Dilatation And Balloon Dilatation With Stent Placement For Left Iliac Vein Compression Syndrome

Background: As early as1906, McMurrich noted the presence of intraluminalvalve—like strictures in left common iliac vein. He proposed a congenital origin of thelesion causing left iliac and femoral vein thrombosis. Thurner and May, in1956,described anatomic variation of the left common iliac vein that resulted in lowerextremity venous outflow obstruction in cadavers. Fibrous vascular lesions called spurswere found at the level where the right artery compressed the left iliac vein against thefifth lumber vertebra．In1965, Thomas and Cockett reported a clinical entity of iliacfemoral venous thrombosis with iliac vein obstruction. The majority of these patientswere found to have an involvement of the left lower extremity, and of those whounderwent surgical exploration showed that fibrous obstruction of the left iliaccompression, a myriad of symptoms. related to venous obstruction symptoms includingacute DVT（Deep Venous Thrombosis）, pain and varicosities, chronic unilateral legedema, can be developed. This condition has been already named as Cockett syndrome,IVCS(Iliac Vein Compress Syndrome) or May-Thurner syndrome. A variety oftraditional therapies that had been used to correct the obstruction and relieve symptomswere ineffective. Recently, endovascular therapies, including balloon dilatation and stentplacement, have been developed as a minimal invasive treatments to accomplish thegoals. And it has become the main method of treatment of the disease.Objective: To investigate the comparison of the methods and healing efficacy betweenmere PTA(percutaneous transluminal angioplasty) treatment and PTA+stentplacement treatment in IVCS in clinical.Material and Method: Retrospective study116IVCS patients from January2011toJanuary2012, divided them into2groups:75cases for mere PTA(percutaneoustransluminal angioplasty) include26males and49females，and the age ranged from20-63years old,and the average age is43.7years old;51cases for PTA+stentplacement include23males and28females,and the age ranged from22-68years old,and the average age is47.5years old. All the cases (126cases) were injected contrast agentvia dorsal vein of left foot to do deep venous anterograde by DSA（digital subtractionangiography）.27cases with antegrade angiography showed left iliac vein was foundunclear and were added the left iliac vein catheterization angiography to make thislesions clear. CT and B ultrasound examination for pelvic were added in22cases, allpatients found no pelvic tumor.75cases underwent mere PTA(ballon diamate rangedfrom8mm-20mm), taking Warfarin orally for3months and adjusting dosage accordingto the INR(Requested an extension between1.5to2.5times to the normal value);51cases underwent PTA+Stent placement(stent diamate ranged from12mm-18mm,20cases planted Bard Luminexx stent,18cases planted OptiMed Sinus stent,3casesplanted Wallstent stent), taking warfarin orally for12months and adjusting dosageaccording to the INR(Requested an extension between1.5to2.5times to the normalvalue). The cases who combined with deep venous insufficiency and varicose veins wereunderwent second surgery,who with venous insufficiency were given the application ofmedical elastic stockings. The cases were followed up to observe the healing effect.Result: There was no mortality in two groups. The mere PTA group:10patients whosuffered with left lower extremity skin ulcers were cured ulcers by anti-inflammatoryand dressing in14patients; Skin pigmentation in15patients disappeared and3hadsignificantly decreased; Chronic left lower limb swelling in12patients disappeared, butthere was slight swelling in17cases;27patients who associated with left lower varicoseveins were underwent surgery treatment, and19patients symptom recurred locally. ThePTA and stent group: all the13patients who suffered with left lower extremity skinulcers were cured ulcers by anti-inflammatory and dressing; Skin pigmentation in18cases disappeared and4had significantly decreased; Chronic left lower limb swelling in21patients disappeared, there was still slight swelling in3cases;20patients whoassociated with left lower varicose veins were underwent surgery treatment, and3patients symptom recurred locally. Iliac vein wall of1case was penetrated during theprocedure of placing stent and caused local hematoma.After expectant treatment thepatient recovered well. Post-stenting angiography saw unobstruction of iliac vein lesionsand stent sprung well in lesions of the vascular segment. After3months of the treatment,mere PTA groups and PTA+Stent placement group had no statistical significance (P>0.05); But after the treatment of12months, restenosis of iliac vein of PTA+Stentplacement group was better significently than mere PTA group (P <0.01). All patients were followed up by DSA and no complications happened such as displacement, fractureand thrombosis. All patients were follows up for6-21months and the average is14.4months. Analyzing the restenosis of iliac vein, variceal recurrence and left limb swellingwe can find out that treatment effect in PTA+Stent placement group was moresignificant than the PTA treatment group (statistically significant, P <0.01), especial inrestenosis of iliac vein.Conclusion: Endovascular intervention for IVCS has a good short-term, medium-termeffect. This treatment has the advantages of small trauma, simple operation, safe andeffective and with few complications, and has became an increasing dominant treatmentfor IVCS as the first choice. PTA+stent placement would be less than mere PTA in iliacvein restenosis, has a better effect.