| Objective :To investigate the timing of treatment of iliac vein lesions after catheter thrombolysis of deep venous thrombosis of lower limbs,and to provide a new strategy and theoretical basis for the selection of the best plan of intracavity treatment.Methods: Clinical data of patients with lower extremity deep vein thrombosis complicated with iliac vein stenosis admitted to the First Affiliated Hospital of Bengbu Medical College from January 2016 to December 2019 were collected.The first stage of endovascular treatment group received inferior vena cava filter implantation + catheter thrombolysis + iliac vein balloon dilation and stent implantation;The staging group received IVC filter implantation plus catheter embolus,continued anticoagulant treatment outside the hospital,and was readmitted to hospital for balloon dilation and stent implantation 1-6 months later.The stent patency rate,thrombosis recurrence rate,Villalta score,Vcss score,VRI score,incidence of deep vein post-thrombotic syndrome（PTS）,hospitalization cost,length of stay,number and length of stents were compared between the two groups.Results:（1）At discharge,the clinical symptoms of the two groups were gradually improved and lower limb edema was relieved.There were no serious complications such as important organ bleeding and pulmonary embolism in both groups.（2）Retrievable filters were implanted in both groups,and the inferior vena cava filters were removed after treatment in most patients except those with short life expectancy and high risk of recurrent thrombosis.After discharge,the total removal rate of inferior vena cava filter was 63.5%（40/63）.The removal rate of inferior vena cava filter in stage I group was 66.7%（24/36）,compared with 59.3%（16/27）in stage II group,and the difference was not statistically significant（P > 0.05）.（3）The number of stents used in stage I group was（0.83±0.37）,and that in stage II group was（1.81±0.46）;The length of stent used in stage I group was（77.94±17.51）mm,the length of stent used in stage II group was（179.31±46.87）mm;the length of hospital stay in stage I group was（14.17±2.76）d,and stage II group was（19.07±1.64）d;The hospitalization cost of the stage group was（65,422.08 ±10927.65）yuan,and that of the stage group was（87311.44±8263.26）yuan;Villalta score of the stage group decreased（6.82±1.45）,while Villalta score of the stage group decreased（5.03±1.95）;The postoperative Vcss score of the primary group was decreased（13.84±2.56）,and that of the staging group was decreased（10.23±1.82）;Postoperative VRI score decreased in stage I group was（8.43±1.72）,and stage II group was（7.14±1.26）.（4）The average follow-up was 6-12 months,and the total first-stage patency rate was 85.7%（54/63）,88.9%（32/36）in the first-stage group and 81.5%（22/27）in the staging group after 12 months of follow-up.There was no statistical significance between the two groups.After further intervention,the patency rate of stage I group and stage II group was 100%.At the followup of 12 months,there were 2 cases of recurrent thrombosis in the stage I group and 2 cases in the stage II group,and there was no statistical significance between the two groups.During follow-up,there were no deaths,stent rupture,or stent displacement.（5）Villalta score was（3.0±1.2）in the stage I group and（4.1±1.1）in the stage II group at 6 months follow-up.The incidence of PTS was 5.6%（2/36）in the stage I group and 7.4%（2/27）in the stage II group,showing no statistical significance between the two groups.At 12 months of follow-up,Villalta score was（4.1±1.6）in the stage I group and（5.2±2.6）in the stage II group,and the comparison between the two groups was statistically significant（P < 0.05）.The incidence of PTS in the stage I group was 11.1%（4/36）,while the incidence of PTS in the stage II group was 18.5%（5/27）,showing no statistical significance.Conclusion: In the short and medium term,the primary and stage endovascular treatment of deep venous thrombosis of lower limbs with iliac venous lesions is effective;There was no significant difference in the early and middle stent patency rate,thrombosis recurrence rate,and the incidence of deep vein post-thrombotic syndrome（PTS）between the stage and stage groups.However,in terms of length of stay、cost of hospitalization、length of stents、number of stents、patency of veins and Villalta score during follow-up,primary treatment is better than staged treatment,which has more clinical promotion value. |
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