髂股静脉支架置入术后再狭窄的影响因素研究进展

doi:10.6040/j.issn.1671-7554.0.2025.0536

摘要/Abstract

摘要： 髂股静脉支架置入术后支架内再狭窄(in-stent restenosis, ISR)的处理是当前血管外科面临的难题。腔内治疗ISR的过程是艰难的。维持支架长期通畅也是一项巨大挑战。明确ISR的危险因素及病理特点有助于维持支架的远期通畅率。本文通过文献检索进行回顾性分析髂股静脉支架置入的手术指征以及ISR发生的近期和远期的危险因素;结合血流动力学原理,进一步分析ISR发生机制;依据ISR的病理特征总结ISR治疗的最新进展,以期为ISR的预防和治疗提供参考。

关键词: 髂股静脉, 支架置入术, 支架内再狭窄, 危险因素, 血流动力学

Abstract: The management of in-stent restenosis(ISR)after iliofemoral vein stenting(IVS)is a challenge currently in vascular surgery. It is difficult for the process of endovascular treatment of ISR. Maintaining long-term stent patency is also a great challenge. Identifying the risk factors and pathological characteristics of ISR may help maintain long-term stent patency. In this article, a retrospectively analysze was conducted on the surgical indications for IVS and the short-term and long-term risk factors for ISR through literature retrieval. Based on hemodynamic principles, the mechanism of ISR was further analyzed. The latest progress in ISR treatment was summarized according to its pathological characteristics. It may provide references for the management of ISR.

Key words: Iliofemoral vein, Stenting, In-stent restenosis, Risk factors, Haemodynamic

中图分类号:

R654.4

程震宇,来庆国,吴梦涛. 髂股静脉支架置入术后再狭窄的影响因素研究进展[J]. 山东大学学报 (医学版), 2025, 63(12): 112-117.

CHENG Zhenyu, LAI Qingguo, WU Mengtao. Advances in influencing factors of in-stent restenosis after iliofemoral vein stenting[J]. Journal of Shandong University (Health Sciences), 2025, 63(12): 112-117.

参考文献

[1] Taha MAH, Busuttil A, Bootun R, et al. A clinical guide to deep venous stenting for chronic iliofemoral venous obstruction[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 258-266.
[2] Saleem T, Raju S. An overview of in-stent restenosis in iliofemoral venous stents[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(2): 492-503.
[3] 中国医师协会血管外科医师分会静脉学组, 史振宇, 吴丹明. 常见静脉疾病诊治规范(2022年版)[J]. 中华血管外科杂志, 2022, 7(1): 12-29. Venous Group of Vascular Sugery Committee of Chinese Medical Doctor Association, SHI Zhenyu, WU Danming. Diagnosis and treatment standard of common venous diseases(2022 version)[J]. Chinese Journal of Vascular Surgery, 2022, 7(1): 12-29.
[4] Kassab G, Raju S. Grading venous stenosis is different from arterial lesions[J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(2): 151-152.
[5] Bai H, Kibrik P, Shaydakov ME, et al. Indications, technical aspects, and outcomes of stent placement in chronic iliofemoral venous obstruction[J]. J Vasc Surg Venous Lymphat Disord, 2024, 12(5): 101904. doi: 10.1016/j.jvsv.2024.101904
[6] Saleem T, Raju S. Comparison of intravascular ultrasound and multidimensional contrast imaging modalities for characterization of chronic occlusive iliofemoral venous disease: a systematic review[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9(6): 1545-1556.
[7] Lau I, Maximilian Png CY, Eswarappa M, et al. Defining the utility of anteroposterior venography in the diagnosis of venous iliofemoral obstruction[J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(4): 514-521.
[8] Jayaraj A, Powell T, Raju S. Utility of the 50% stenosis criterion for patients undergoing stenting for chronic iliofemoral venous obstruction[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9(6): 1408-1415.
[9] Yang YH, Zhao Y, Chen Z, et al. The effect of stent compression on in-stent restenosis and clinical outcomes in iliac vein compression syndrome[J]. Quant Imaging Med Surg, 2021, 11(6): 2245-2252.
[10] Jayaraj A, Fuller R, Raju S, et al. In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 42-51.
[11] Fu J, Tang B, Wang HY, et al. Stent characteristics of 32 patients with early(<14 days)iliofemoral stent occlusion[J]. J Vasc Surg Venous Lymphatic Disord, 2021, 9(4): 881-887.
[12] Kim MS, Park HS, Hong HP, et al. Risk factors for stent occlusion after catheter-directed thrombolysis and iliac vein stenting in the treatment of May-Thurner syndrome with iliofemoral deep vein thrombosis: a retrospective cohort study[J]. Quant Imaging Med Surg, 2022, 12(12): 5420-5432.
[13] Ye KC, Lu XW, Jiang ME, et al. Technical details and clinical outcomes of transpopliteal venous stent placement for postthrombotic chronic total occlusion of the iliofemoral vein[J]. J Vasc Interv Radiol, 2014, 25(6): 925-932.
[14] Avgerinos ED, Saadeddin Z, Abou Ali AN, et al. Outcomes and predictors of failure of iliac vein stenting after catheter-directed thrombolysis for acute iliofemoral thrombosis[J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(2): 153-161.
[15] Ardita V, Galati N, Miglioranza E, et al. Endovascular treatment of chronic ilio-femoral vein obstruction with extension below the inguinal ligament in patients with post-thrombotic syndrome[J]. J Vasc Surg Venous Lymphat Disord, 2024, 12(3): 101816. doi: 10.1016/j.jvsv.2024.101816
[16] Zhou YD, Guan YB, Xue M, et al. Clinical outcomes of stenting extending below the inguinal ligament for treatment of chronic iliofemoral venous obstruction[J]. Ann Vasc Surg, 2021, 75: 259-266. doi: 10.1016/j.avsg.2021.01.115
[17] Pu HJ, Lei JH, Du GD, et al. Antiproliferative agent attenuates postthrombotic vein wall remodeling in murine and human subjects[J]. J Thromb Haemost, 2025, 23(1): 325-340.
[18] Ozcinar E, Dikmen N, Kayan A, et al. Pharmacomechanical thrombectomy and catheter-directed thrombolysis, with or without iliac vein stenting, in the treatment of acute iliofemoral deep vein thrombosis[J]. J Cardiovasc Dev Dis, 2024, 11(7): 214. doi: 10.3390/jcdd11070214
[19] Espitia O, Douane F, Hersant J, et al. Predictive factors of stent patency in iliofemoral venous diseases in a multicentre cohort study[J]. Eur J Vasc Endovasc Surg, 2023, 65(4): 564-572.
[20] van Vuuren TM, Doganci S, Toonder IM, et al. Venous stent patency may be affected by collateral vein lumen size[J]. Phlebology, 2019, 34(1): 32-39.
[21] 吴鸿飞, 肖占祥, 曾昭凡, 等. 髂静脉支架置入术后支架闭塞的危险因素分析[J]. 中国普通外科杂志, 2022, 31(12): 1605-1611. WU Hongfei, XIAO Zhanxiang, ZENG Zhaofan, et al. Analysis of risk factors for stent occlusion after iliac vein stenting[J]. Chinese Journal of General Surgery, 2022, 31(12): 1605-1611.
[22] Pouncey AL, Kahn T, Morris RI, et al. Risk factors and classification of reintervention following deep venous stenting for acute iliofemoral deep vein thrombosis[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(5): 1051-1058.
[23] Li GQ, Hu B, Sun Y, et al. Histological features of in-stent restenosis after iliac vein thrombus removal and stent placement in a goat model[J]. J Vasc Interv Radiol, 2024, 35(4): 611-617.
[24] Hoshino Y, Yokoi H. Angioscopic evaluation after venous stents[J]. J Vasc Surg Venous Lymphat Disord, 2023, 11(1): 136-142.
[25] Li CQ, Zhan YQ, Wang ZM, et al. Effect of stent treatment on hemodynamics in iliac vein compression syndrome with collateral vein[J]. Med Eng Phys, 2023, 115: 103983. doi: 10.1016/j.medengphy.2023.103983
[26] 李超群, 詹焱青, 汪忠明, 等. 髂静脉压迫综合征血流动力学数值模拟[J]. 北京航空航天大学学报, 2024, 50(8): 2646-2654. LI Chaoqun, ZHAN Yanqing, WANG Zhongming, et al. Numerical simulation of iliac vein compression syndrome in hemodynamics[J]. Journal of Beijing University of Aeronautics and Astronautics, 2024, 50(8): 2646-2654.
[27] Hu JM, Feng HQ, Zheng YL, et al. Mechanism of effect of stenting on hemodynamics at iliac vein bifurcation[J]. Comput Biol Med, 2024, 170: 107968. doi: 10.1016/j.compbiomed.2024.107968
[28] Fan ZM, Lu J, Cheng H, et al. Insights from computational fluid dynamics and in vitro studies for stent protrusion in iliac vein: how far shall we go?[J]. Cardiovasc Eng Technol, 2025, 16(1): 79-90.
[29] Li CS, Feng HQ, Wang XT, et al. The influencing mechanism of iliac vein stent implantation for hemodynamics at the bifurcation[J]. Comput Methods Biomech Biomed Engin, 2023, 26(12): 1452-1461.
[30] Raju S, Knight A, Buck W, et al. Caliber-targeted reinterventional overdilation of iliac vein Wallstents[J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(2): 184-194.
[31] Robertson C, Varcoe RL, Black S, et al. Histopathology of iliocaval venous in-stent restenosis treated with directional atherectomy[J]. J Endovasc Ther, 2019, 26(5): 742-746.
[32] Jayaraj A, Fuller R, Raju S. Role of laser ablation in recalcitrant instent restenosis post iliofemoral venous stenting[J]. J Vasc Surg Cases Innov Tech, 2021, 7(2): 298-301.
[33] Lei JH, Pu HJ, Zhang LJ, et al. Drug-coated balloon therapy for in-stent restenosis in patients with iliofemoral deep vein thrombosis: a single-arm observational study[J]. Catheter Cardiovasc Interv, 2024, 103(5): 752-757.

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