| Objective To investigate the risk factors of stent occlusion after iliac vein stenting and construct a clinical prediction model.Methods The clinical data of 150 patients who attended the Shandong Provincial Hospital affiliated to Shandong University and Shandong Rongjun General Hospital for iliac vein stenting from January 2013 to June 2020 were retrospectively analyzed.Postoperative follow-up was 1 year,and 50 patients with occlusion of the iliac vein stent during the follow-up period were selected as the occlusion group,and 100 patients without occlusion of the iliac vein stent were the control group.The patients’clinical data,including age,sex,days of hospitalization,etiology,number of combined coronary artery disease,number of combined arteriovenous fistula,number of combined cerebrovascular disease,number of combined malignancy,number of combined diabetes mellitus,number of combined hypertension,prothrombin time,activated partial prothrombin kinase time,fibrinogen level,D-dimer level,C-reactive protein level,number of stents,total stent length,stent diameter,duration of surgery,postoperative anticoagulation time,postoperative anticoagulation regimen,receipt of compression therapy,recanalization rate of external iliac vein,recanalization rate of common femoral vein,recanalization rate of femoral vein,were collected and analyzed by univariate analysis,the single factors with significant differences between groups were compared and substituted into binary logistic regression analysis for independent risk factor test to screen the risk factors for stent occlusion after iliac vein stent placement.The accuracy of the prediction model was verified by plotting the calibration curve of the model and calculating the consistency index,plotting the subject’s work characteristics curve and clinical decision curve.Results1.Comparison of baseline information of patients in two groupsThere were no statistically significant differences in age,hospitalization days,BMI,number of smoking history and history of alcohol consumption between the two groups（P>0.05）;there were statistically significant differences in gender and etiology between the two groups（P<0.05）.2.Comparison of combined diseases between the two groups of patientsThere was no statistically significant difference between the two groups in the number of patients with combined coronary heart disease,combined cerebrovascular disease,combined malignant tumor and combined diabetic patients（P>0.05）;there was statistically significant difference between the two groups in the number of patients with combined hypertension and combined arteriovenous fistula（P<0.05）.3.Comparison of blood indexes between the two groups of patients There was no statistically significant difference in PT,APTT,FIB and DD levels between the two groups（P>0.05）;there was statistically significant difference in CRP levels between the two groups（P<0.05）.4.Comparison of surgical data between the two groups of patients There was no statistically significant difference in the number of stents placed,stent diameter and operation time between the two groups（P>0.05）;there was statistically significant difference in total stent length between the two groups（P<0.05）.5.Comparison of postoperative interventions between the two groups There was no statistically significant difference between the two groups in terms of postoperative anticoagulation time,postoperative anticoagulation regimen,and receipt of compression therapy（P>0.05）.6.Comparison of the recanalization rate of iliac vein stent inflow tract between the two groups of patientsThere was no statistically significant difference between the two groups in terms of recanalization rate of common femoral vein and femoral vein between the two groups of patients（P>0.05）;there was statistically significant difference in the recanalization rate of external iliac vein between the two groups of patients（P<0.05）.7.Analysis of independent risk factors for iliac vein stent occlusionLogistic regression analysis was used to statistically analyze the independent risk factors for iliac vein stent occlusion.The occurrence of stent occlusion was used as the dependent variable,and the gender,etiology,the number of combined hypertension,the number of combined arteriovenous fistula,APTT and CRP levels,total stent length,the recanalization rate of external iliac vein,which had significant differences,were screened out by univariate analysis as independent variables and logistic regression analysis was performed.The results showed that gender,etiology,arteriovenous fistula,APTT and the recanalization rate of external iliac vein were independent risk factors for iliac vein stent occlusion（P<0.05）.8.Prediction model constructionAccording to the results of logistic regression analysis,gender,etiology,arteriovenous fistula,APTT level and the recanalization rate of external iliac vein were used to construct a prediction model and draw a column line graph,and a scoring system was also constructed.The consistency index was calculated to be 0.865,and the consistency index was 0.861 after validation using the internal validation method.the model calibration curve overlapped well with the actual curve.The area under the ROC curve to verify the accuracy of the model was 0.859,and the accuracy of the model for clinical application was good.Conclusion1.Patients with iliac vein stent occlusion had higher CRP and lower APTT level,a greater number of female,hypertension,iliac vein stenosis and arteriovenous fistula,poorer rates of external iliac vein recanalization,longer total stent length compared with patients with stent patency during the follow-up period.2.With the univariate and multifactorial regression analyses,gender,etiology,arteriovenous fistula,APTT level and the recanalization rate of external iliac vein were independent risk factors affecting stent occlusion after iliac vein stenting.3.The accuracy of the clinical prediction model for stent occlusion after iliac vein stenting constructed in this study was good. |
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