Changes Of Venous Pressure Of Lower Extremities Before And After Operation For Non-thrombotic Iliac Vein Compression Syndrome With Varicose Veins Of Lower Extremities

Objective:To investigate the changes of the venous pressure of lower extremities and Postoperative efficacy before and after endovenous therapy combined with high ligation and stripping of great saphenous veins for non-thrombotic iliac vein compression syndrome and varicose veins of lower extremities.Methods:Prospective analysis of patients were diagnosed as non-thrombotic iliac vein compression syndrome?iliac vein stenosis rate>50%?with varicose veins of lower extremities?CEAP?C3?by Anterograde Venography of lower extremities,femoral vein catheter angiography and combined with clinical manifestations from The Second Affiliated Hospital of Ningxia Medical University between January 2018 to July 2018.Endovascular therapy combined with high ligation and stripping of great saphenous vein was successfully performed in the same period.Respectively to compare preoperative and postoperative 12days,preoperative and postoperative 6 months,12 days after surgery and postoperative 6months lower limb Static venous pressure?P₀?,post-exercise minimum venous pressure(P_min),90%of the venous refux time(RT₉₀),Pressure drop ratio[Pd=(P₀-P_min)/P₀×100%]difference,analyzing the change of the venous pressure before and after operation.According to the CEAP classification,the severity of the patients was divided into three groups:C3?mild?,C4?moderate?,and C5C6?severe?.The differences of Pd values between the three groups were compared preoperative,postoperative 12 days and postoperative 6 months,analysis of venous pressure changes in patients with different stages.The correlation between preoperative P_min,RT₉₀ and CEAP classification was analyzed.The improvement of clinical symptoms was evaluated by VCSS score,edema relief rate,skin pigmentation improvement rate,ulcer healing rate and venous claudication relief rate.SPSS21.0 statistical software was used for statistical analysis,with P<0.05 as the statistical difference.Results:A total of 56 cases were collected,there were 30 males and 26 females,age ranged from 21 to 75 years,average 52.47+12.87 years.There were 42 cases of left lower limb,10 cases of right lower limb and 4 cases of double lower limb,with a total of 60 affected limbs.CEAP clinical classification:C3:23 limbs,C4:23 limbs,C5:5 limbs,C6:12 limbs.Among the endovenous therapy patients,28 limbs underwent simple balloon dilatation,and32 limbs underwent balloon dilatation combined with stent implantation.Postoperative 12days and postoperative 6 months P₀,P_min,RT₉₀,Pd were significantly improved than preoperative,there were significant statistical difference in P₀,P_min,RT₉₀ and Pd?p<0.05?.There was no significant difference in P₀ between postoperative 12 days and postoperative 6 months?p>0.05?.There were significant difference in P_min,RT₉₀ and Pd had between postoperative 12 days and postoperative 6 months?p<0.05?.The Pd values at the stages of C3 and C4,C3 and C5C6,C4 and C5C6 were statistically different in the preoperative,postoperative 12 days and postoperative 6 months,respectively?p<0.05?.In addition,Pd improvement was worse in C5C6 stages compared with C3 and C4 stages at postoperative 6 months.The VCSS score was significantly lower postoperative 6 months than preoperative,and there was significant statistical difference?p<0.05?.The edema relief rate was 92.7%?51/55?,ulcer healing rate was 83.3%?10/12?,pigmentation relief rate was 92.5%?37/40?,pain relief rate was 84.2%?16/19?.There was a positive correlation between P_min and CEAP grade C3^C6?correlation index r=0.595?,and RT₉₀ was negatively correlated?correlation index r=-0.523?,all of which had statistically significant differences?p<0.05?.Conclusion:1.Endovascular therapy combined with high ligation and stripping of great saphenous veins can effectively reduce the dynamic venous pressure of lower extremities,improve the function of valves and gastrocnemius pump,and effectively alleviate clinical symptoms in patients with non-thrombotic iliac vein compression syndrome and varicose veins of lower extremities,however,the recovery of venous pressure in patients with severe venous insufficiency was less than that in patients with mild to moderate venous insufficiency.2.P_min was positively correlated with the severity of CVI and negatively correlated with RT₉₀,P_min and RT₉₀ can be used as an effective indicator for evaluating venous function.