Clinical Study On Hemodynamics In Stent Angioplasty Of Cockett Syndrome

Objective Through clinical experimental studies,this paper discussed the effect of lower extremity venous pressure and symptoms related to CVI after the stent angioplasty in Cockett syndrome,and provide the surgical indications of stent angioplasty of Cockett syndrome with theory.Methods 93 cases of Cockett Syndrome patients treated with Stent Angioplasty were recruited for the experiment,we will collect the clinical data and record the changes of symptoms and signs related to Cockett Syndrome.They are all from the vascular surgery department of Quzhou People’s Hospital which is affiliated to Zhejiang University of Chinese Medicine from October,2015 to October,2017.First,making clear diagnosis of valvular regurgitation and stenosis of left common iliac vein by lower limb vein retrograde angiography in DSA and CTA,combine the Kistner classification and the principle of randomization,all patients were divided into 3 groups by randomized number table and the degree of valvular regurgitation:Group A,KistnerⅡl evel,mild reflux;Group B,KistnerⅢ,moderate reflux;group C,KistnerⅣ,severe reflux.Then in the resting state in standing,3groups were separately measured the pressure difference at the start of great saphenous vein of the left ankle around angioplasty treatment of Cockett syndrome,and compare pressure drop rate with each other around the angioplasty treatment of Cockett syndrome;In January,march and June,we record the change of symptoms and signs related to CVI on the basis of CEAP,and record improvements of lower limb acid bilges,edema,ulcers,and uses the mean±standard deviation,and data analysis using IBM SPSS 22.0 software,p<0.05,it is thought that the difference is of statistically significant.According to the saphenous vein pressure change and the preoperative,postoperative symptoms of follow-up,we value the safety and efficacy of stent angioplasty treatment of Cockett syndrome differences under different hemodynamics,and summarize the indications for treatment ofstent angioplastyof Cockett syndrome.Results According to retrograde angiography of the inferior vena cava,29 patients in group A（KistnerⅡ,mild reflux）,31 patients in group B（KistnerⅢ,moderate reflux）,and 33 patients in group C（KistnerⅣ,severe reflux）.Respectively,in group A,group B and group C,the pressure difference in the supine position of the saphenous vein at the left ankle was（8.63±2.97）cm H₂O,（13.63±3.68）cm H₂O,（21.63±3.27）cm H₂O.The reduction rates of the pressure in the supine position were（17.46±1.83）%、（18.36±1.98）%、（25.45±1.12）%,respectively.The pressure differences at the start of the vein were（15.31±2.16）cm H₂O,（13.31±1.67）cm H₂O and（9.31±1.78）cm H₂O,respectively,and the reduction rates of station pressure were（14.46±1.71）%、（12.96±1.97）%、（10.5±2.12）%respectively.There was significant difference between the three groups in the rate of pressure reduction and the effective rate of stenting（P<0.05）,There was no significant difference in the incidence of surgical complications（P>0.05）.The 6-month follow-up showed that the effective remission rates of the three groups were（68.46±14.70）%,（59.66±15.98）%and（49.45±18.12）%respectively,and the remission rates of edema symptoms were（72.69±14.30）,（59.80±17.92）%and（52.14±17.72）%respectively.The cure rates of ulcer were 31.03%,18.64%and8.62%,respectively.The difference was of statistically significant（P<0.05）.The total effective rate of group A,group B and group C was96.55%,87.10%,78.78%,respectively,and the difference was of statistically significant（P<0.05）.Conclusion1.In the hemodynamic evaluation of patients with Cockett’s syndrome,the more serious venous insufficiency of the left lower extremity,the lower rate of venous pressure in the left lower extremity and the lower rate of postoperative symptom relief.Hemodynamics changes can guide the treatment of Cockett syndrome;2.when evaluated by hemodynamics of standing position,the left lower vein valve disfunction is more severe,the lower rate of left lower limb vein pressure decrease and the lower decrease of CVI will be;3.Angioplasty in the treatment of Cockett syndrome,the degree of patient’s venousinsufficiency severity can affect the surgical efficacy;4.Patients who have valvular venous insufficiency and a large number of pelvic collateral circulation accept angioplasty in the treatment of Cockett syndrome,follow-up symptoms of left limb improvement was not obvious or even worse.Whether patients who have Cockett syndrome with severe valvular dysfunction and collateral circulation receive stent angioplasty may need further discussion.