Comparison Of Clinical Efficacy Of Anticoagulant And Antiplatelet Therapies After Stent Implantation For Nonthrombotic Iliac Vein Compression Lesions

Objective:By collecting relevant case data and then carrying on statistical analysis,this study is intended to explore the prophylaxis efficacy of anticoagulant drugs and antiplatelet drugs in intravenous stent dysfunction after stent implantation for nonthrombotic iliac vein compression lesions(NIVCL),so that to analyze the advantages and disadvantages of the two methods and evaluate their efficacy.Background:Intravascular treatment of nonthrombotic iliac vein compression lesions(NIVCL),such as saccule dilation and stent implantation,has become the preferred treatment method because of its safety and effectiveness and low recurrence rate.The outcomes of these intravascular treatments are variable and lack of long-term patency rate studies.Little is known about the potential factors associated with the patency of the iliac vein stent,which is usually dependent on data extrapolation applied to arterial intervention therapy.The purpose of this study is to identify factors predicting venous stent dysfunction and to compare the effects of anticoagulant and antiplatelet therapies on the patency rate of iliac vein stents,so as to better understand the underlying mechanisms and improve patient management after surgery.Materials and methods:In this study,retrospective analysis was conducted for 91 patients with nonthrombotic iliac vein compression lesions(NIVCL)who have received technically successful intravascular iliac vein stent implantation at the Department of Vascular Surgery of the Second Affiliated Hospital of Suzhou University and the Kunshan Traditional Chinese Medicine Hospital between May 2016 and April 2019.Depending on the treatment method,patients were divided into anticoagulant group(Group A)and antiplatelet group(B).The age ranged from 44 to 80 years old,39 cases of male,52 cases of female.Symptoms of all patients were above grade 3 according to CEAP.The clinical symptoms included lower limb swelling,lower limb pain,lower limb skin eczema or pigmentation and skin ulcers.Before surgery,all patients received intravenous pyelography of the left lower limb to confirm the iliac vein was compressed without thrombosis,and enhanced CT examination was performed on the lower abdomen to exclude other external pressure(tumor,etc.).Through the left femoral vein intervention,the left iliac vein saccule dilation and stent implantation was performed,and a stent was placed at the proximal end of the left iliac vein to cover the lesion area.Within 3 days after surgery,the left saphenous vein high ligation and exfoliation+endovenous laser treatment(EVLT)was performed.In which,after the intravascular treatment of NIVCL,the anticoagulant group(group A)was treated with subcutaneous injection of low molecular weight heparin sodium once daily with bridge warfarin oral administration,regular monitoring of coagulation function,adjusting the international normalized ratio(INR)to Between 2.0-3.0.The antiplatelet group(group B)was treated with oral administration of aspirin 100 mg once daily as antiplatelet therapy.Group A and group B were treated for at least 3 months,while wearing elastic stockings(pressure level 2)for more than 3 months.follow-up visit to the hospital or telephone follow-up survey was performed in January,March,June,and December after discharge,and continue followed up visit once a year.Follow-up examinations mainly include CEAP classification,B-ultrasound,CTV,and venography.Data of hospitalization days,preoperative and postoperative CEAP grading,complications at the sites of puncture,assessment of stent patency,and the rate of thrombosis were collected and analyzed statistically.Results:By using the above method,91 patients with NIVCL received stent implantation,with an average follow-up visit time of 14.8 months.Among which,39 were anticoagulant therapy group(Group A):16 cases were male and 23 were female.The remaining 52 cases were in the pure antiplatelet treatment group(Group B):23 cases were male and 29 were female.Of the 39 patients in Group A,1 patient had a right iliac vein thrombosis,1 had stent displacement to the inferior vena cava,and 1 had a left iliac vein stent distal thrombosis.Of the 52 patients in group B,1 had thrombosis in the left iliac vein.The in-stent patency rate of the two groups at the 12th month of follow-up visit was 97.43%and 98.07%respectively,that the difference has no statistical significance.After stent implantation,43%received anticoagulant therapy and 57%received antiplatelet therapy.The hospitalization days in groups A and B were 6.86 ± 1.12 and 5.27±1.53,respectively,that the difference has statistical significance.The incidence of postoperative complications was 12.8%and 9.6%respectively,that the difference has no statistical significance.Through multivariate regression analysis,there was no significant difference in stent patency rate between anticoagulation or antiplatelet therapies after stenting for nonthrombotic iliac vein compression lesions.Conclusions:1.Intravascular treatment of nonthrombotic iliac vein compression lesions(NIVCL)is safe and effective,easy to operate,with less complications,which can lead to a satisfactory patency rate.2.After stent implantation for patients of Nonthrombotic iliac vein compression lesions(NIVCL),through anticoagulant and antiplatelet treatments,there is no significant difference in the improvement of symptoms,patency rates and the incidence of complications.