Objective To investigate the effect of common iliac vein allograft replacing the portal vein-superior mesenteric vein transition area invaded by pancreatic cancer. Methods The clinical data of a patient with pancreatic cancer admitted to the Beijing Tsinghua Changgung Hospital in December 2021 who underwent pancreaticoduodenectomy combined with common iliac vein allograft replacing the junction of portal vein, superior mesenteric vein and splenic vein were analyzed retrospectively. The patient was a 77-year-old man who complained of “epigastric pain for 1 month and pancreatic mass was found for 1 week”. After admission, the patient was diagnosed with pancreatic cancer through inspection, and then the surgery was required. Preoperative examination and intraoperative exploration confirmed that the junction of portal vein, superior mesenteric vein, and spleen vein was invaded by tumor. In addition, the length of the invaded vessels measured by preoperative 3D reconstruction image was 5.5 cm, and the distance between the broken end of portal vein and the broken end of superior mesenteric vein measured was 4.5 cm during the operation. After tumor and vessels were resected, vascular anastomosis could not be performed directly. After accurate evaluation, pancreaticoduodenectomy combined with common iliac vein allograft replacing the junction of portal vein, superior mesenteric vein and splenic vein was performed. The operative time was 11 h, and the intraoperative blood loss was 400 mL. After the operation, the routine treatment was performed in ICU and was transferred to the general ward on the 7th day. Postoperative laboratory tests were performed to monitor liver function changes routinely, and imaging examination were was performed to monitor portal venous system blood flow. Results Postoperative complications such as biliary fistula, pancreatic fistula, hemorrhage, infection and thrombosis were not occurred. Postoperative pathological diagnosis: pancreatic ductal adenocarcinoma, medium-low differentiation. Enhanced CT reexamination on the 2nd and 13th day after the operation showed that the blood flow at the junction of portal vein, superior mesenteric vein and splenic vein of the common iliac vein allograft was unobstructed, and there was no stenosis or thrombosis at each anastomosis. Conclusions The application of common iliac vein allograft replacing the portal vein-superior mesenteric vein transition area invaded by pancreatic cancer is safe and feasible. The short-term efficacy is satisfactory, and long-term prognosis remains to be further observed.
ObjectiveTo compare the efficacy of varicose great saphenous vein (GSV) treatment alone versus combined treatment with iliac vein compression (IVC) intervention in improving lower extremity symptoms and prognosis among the patients with varicose GSV complicated by IVC. MethodsBased on inclusion and exclusion criteria, the patients with varicose GSV complicated by IVC treated at the Day Service Center of the First Affiliated Hospital of Chongqing Medical University from May 2022 to January 2025 were retrospectively enrolled. The patients were assigned into two groups according to the treatment strategies: the varicose GSV treatment alone group (control group) and the combined treatment group for varicose GSV and IVC (observation group). The primary endpoints included the closure rate of the GSV trunk, venous clinical severity score (VCSS), and venous insufficiency epidemiological and economic study quality of life/symptom (VEINES-QOL/Sym) questionnaire score at 6 and 12 months postoperatively. The significance level was set at α=0.05. ResultsA total of 264 patients with left lower extremity varicose GSV complicated by IVC were included. The observation group comprised 32 patients, while the remaining 232 patients underwent 1∶3 propensity score-matching, resulting in 96 matched patients in the control group. The baseline characteristics, including gender, age, and comorbidities, showed no statistically significant differences between the two groups (P>0.05). At 12 months postoperatively, the GSV trunk closure rate was 100% in both groups. Within-group comparisons revealed significant improvements in the VCSS and VEINES-QOL/Sym points at 6 and 12 months as compared with preoperative (on admission) values (P<0.05). Between-group comparisons showed that the observation group had greater improvement in the VEINES-QOL/Sym score at 6 months (P=0.028), but no significant difference in the VCSS (P=0.775); At 12 months, the observation group demonstrated significantly better the VCSS (P<0.001) and VEINES-QOL/Sym points (P<0.001) as compared with the control group. ConclusionsFor patients with left lower extremity GSV varicosities complicated by IVC, both treatment strategies significantly improve symptoms. Results of short-term follow-up (6 months) demonstrate early advantages in quality of life improvement with concurrent IVC intervention, while results of 12-month follow-up indicate superior efficacy in both symptom relief and quality of life enhancement. Therefore, concurrent IVC intervention may provide greater clinical benefits for mid- to long-term prognosis for patients with left lower extremity GSV varicosities complicated by IVC.
ObjectiveTo summarize strategy of diagnosis and treatment of thrombotic iliac vein stenosis in recent years.MethodThe relevant literatures in recent 5 years on the current status and trend of diagnosis and treatment of the thrombotic iliac vein stenosis were reviewed.ResultsAt present, the diagnostic methods of thrombotic iliac vein stenosis mainly included that the multi-slice spiral CT, venography, intracavitary ultrasound, magnetic resonance imaging, color Doppler ultrasound and other imaging examinations, each of which had its advantages and disadvantages. There were still no uniform criteria whether a filter should be placed, whether the stents should and how to be placed, and when to intervene in the patients with acute thrombotic iliac vein stenosis. There was no definite conclusion when and how to effectively intervene in the patients with chronic thrombotic iliac vein stenosis.ConclusionsIncidence of thrombotic iliac vein stenosis is high and sequela is severe. Early diagnosis and reasonable treatment are very important. Only strictly grasping indications, combining medical technology and patient’s condition, and adopting appropriate treatment strategy, can make patients’ maximal benefit.
Objective To explore the feasibility of clinical application of hepatic artery （HA） or proper hepatic artery （PHA） anastomosing with superior mesenteric artery （SMA） and internal iliac vein （IIV） anastomosing with superior mesenteric vein （SMV） or portal vein （PV） in the extended pancreaticoduodenectomy combined with vascular resection．Methods The HA，PHA，SMA， SMV， PV， and IIV were dissected on 20 adult corpses， and the length， thickness，and lumen diameter of blood vessels were measured and compared with the results of multislice spiral CT scan，magnetic resonance angiography，or color Doppler in 25 patients with pancreatic head carcinoma．The extended pancreaticoduodenectomy was carried out on 5 patients of pancreatic head carcinoma with vascular invasion according to the mathcing results，and the reconstructions of HA or PHA with SMA and IIV with SMV or PV were performed．Results According to autopsy，HA-PHA was （5.50±1.50） cm in length，（0.20±0.01） mm in thickness，（5.02±1.32） mm in lumen diameter；and SMA was （4.00±1.00） cm in length，（0.21±0.01） mm in thickness，（6.05±1.06） mm in lumen diameter．The lumen diameter of left IIV，right IIV，and PV or SMV was （11.06±0.16） mm，（11.10±0.13） mm，and （11.56±0.20） mm，respectively．The thickness of left IIV，right IIV，and PV or SMV was （0.10±0.01） mm，（0.10±0.02） mm，and （0.10±0.02） mm，respectively．The multislice spiral CT scan，magnetic resonance angiography，color Doppler，and selective arteriography in vivo showed that the thickness and lumen diameter of HA-PHA and SMA were wider （0.1 mm and 0.3 mm） than those of the autopsy results，and there were no statistic significances （P＞0.05），but the length of HA-PHA was longer （1－2 cm） than that of SMA，and there was statistic significance （P＜0.05）. The survival of 5 patients with extended pancreaticoduodenectomy combined with PHA or SMA and IIV-PV/SMV resection and reconstruction was longer than that of palliative surgery patients or giving-up patients at the same period，and no long-term complications occurred．Conclusions The vascular invasion of pancreatic head carcinoma is not an absolute contraindication of radical pancreaticoduodenectomy．The survival of 5 patients with vascular invasion of pancreatic head carcinoma in this group is prolonged by extended pancreaticoduodenectomy combined with vascular resection and reconstruction as compared with palliative surgery group at the same period．HA，PHA，and IIV are the best autologous vascular alternative materials without more complications． Being familiar with regional anatomy will guide the surgeons in extended pancreaticoduodenectomy.
ObjectiveTo evaluate the safety and mid-to-long term outcomes of catheter-directed thrombolysis (CDT) in combination with percutaneous mechanical thrombectomy (PMT) followed by stent placement treatment for acute proximal deep vein thrombosis (DVT) complicated by iliac vein compression syndrome (IVCS), and to identify risk factors relevent to primary stent restenosis. MethodsA retrospective study was conducted. The patients diagnosed with acute proximal DVT and concurrent IVCS who underwent CDT in combination with PMT followed by stent placement at the First Affiliated Hospital of Chongqing Medical University from January 2018 to December 2021 were included. The demographics, clinical history, and procedural data were collected. The postoperative follow-up using color Doppler ultrasound were scheduled at 3, 6, and 12 months, and annually thereafter. The primary and secondary stent patency rates were evaluated. The univariate and multivariate Cox proportional hazards regression models were employed to assess risk factors for primary stent restenosis. ResultsA total of 188 patients who met the inclusion and exclusion criteria were enrolled, underwent CDT combined with PMT and stent implantation, and completed follow-up. During the follow-up, the restenosis occurred in 26 patients. The cumulative primary patency rates at 3, 6, 12, 24, 36, and 48 months after surgery were 100%, 98.9%, 92.5%, 88.3%, 86.7%, and 86.2%, respectively. The multivariate Cox proportional hazards regression analysis confirmed that a history of previous DVT [HR (95%CI)=4.21 (1.73, 10.28), P=0.002], implantation of two or more stents [HR (95%CI)=11.85 (1.66, 84.63), P=0.014], stent crossing the inguinal ligament [HR (95%CI)=9.92 (1.87, 52.78), P=0.007], and stent length [HR (95%CI)=0.98 (0.97, 0.99), P=0.003] were the affecting factors for primary restenosis. ConclusionsThe findings of this study suggest that CDT combined with PMT and stent implantation is a safe and effective strategy for treating acute proximal DVT complicated by IVCS. Close attention should be paid to the occurrence of restenosis in patients with two or more stents, stent crossing the inguinal ligament, and a history of previous DVT.
On January 11, 2022, the European Society of Vascular Surgery (ESVS) completed its first update in the “European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” since 2015. Based on the existing literatures and expert consensus, the guidelines added and revised the treatment strategies, postoperative monitoring, and postoperative anticoagulation of superficial venous insufficiency of the lower extremities and pelvic venous diseases. The new and modified parts will be interpreted.
ObjectiveTo evaluate the efficacy and safety of intracavitary treatment for iliac vein compression syndrome（IVCS）with acute lower extremity deep venous thrombosis (DVT).MethodsThe clinical data of 57 patients with IVCS and lower extremity DVT, who undergoing with stent implantation, balloon expansion and Angiojet rheolytic thrombectomy from June 2015 to June 2018, were retrospectively analyzed. The effect of treatment was evaluated by the changes of thigh circumference difference between the affected side and the healthy side, and the thrombosis clearance rate in the operating. In addition, the incidence of post-thrombotic syndrome (PTS) and stent patency rate were analyzed after long-term follow-up based on the change of Villaita scale score and ultrasound examination of lower extremity veins.ResultsThe success rate of surgical technique was 100%, and there was no pulmonary embolism during operating and postoperative. Lower extremity deep vein thrombosis clearance levels Ⅲ 48 cases (84.2%), Ⅱ 9 cases (15.8%), the changes of thigh circumference difference between the affected side and the healthy side from preoperative (5.8±1.7) cm to (3.7±1.0) cm. One year follow-up after operation, the primary patency rate of stent was 86.0% and PTS occurred in 8 patients (14.0%).ConclusionStent implantation, balloon expansion and Angiojet rheolytic thrombectomy for IVCS with acute lower extremity DVT is a safe, effective with low incidence of complications and efficient thrombus clearance.
ObjectiveTo compare the improvement of clinical symptoms and patency of stents in patients with left and right non-thrombotic iliac vein compression syndrome (NIVCS) after endovascular stent therapy. MethodsThe clinical data of patients with NIVCS admitted to the First Affiliated Hospital of Chongqing Medical University from January 2016 to January 2021 were analyzed retrospectively. The venous clinical severity score of the patients’ veins before therapy and on month 12 after therapy was analyzed. At the same time, the patencies of stents on month 1, 3, 6, and 12 after stenting were also analyzed. ResultsA total of 164 patients with NIVCS were collected, including 144 left NIVCS and 20 right NIVCS. The surgical technique success rate of endovascular stent therapy was 100% (164/164). There was no statistical difference of the venous clinical severity score between the patients with left and right NIVCS on month 12 after therapy (t=1.265, P=0.208), but the venous clinical severity score of left and right NIVCS patients on month 12 after therapy were lower than those before therapy (t=27.534, P<0.001; t=10.047, P<0.001). The accumulative one-stage stent patency rate on month 12 after therapy was 96.5% and 94.7% in the patients with left and right NIVCS, respectively (χ2=0.160, P=0.689). After the stent was fully supported and completely covered the extent of the lesion, the short-term (within 12 months) stent patency rates of the patients with different compression site of the iliac vein, as well as type, diameter, and length of stent placement had no statistical differences (P>0.05). ConclusionFrom the results of this study, whether left NIVCS or right NIVCS, endovascular stent therapy is safe and effective.
Venous occlusive diseases include acute deep vein thrombosis, as well as chronic iliac vein compression syndrome and post thrombotic syndrome. These diseases can lead to severe venous hypertension which greatly affect life quality. So domestic and international vascular society both have published several guidelines and consensus focusing on these diseases including the “Diagnosis and Treatment Standard about Common Venous Diseases 2022” by Vein Group of Vascular Surgery Committee from Chinese Medical Doctor Association, “2021 Clinical Practice Guidelines on the Management of Venous Thrombosis” and “2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” by European Society of Vascular Surgery. Herein, we make a comparison and explanation of these guidelines and consensus to provide reference to the management of venous occlusive diseases.
ObjectiveTo investigate the clinical efficacy of AngioJet thrombectomy combined with iliac vein stenting for patients diagnosed with acute lower extremity deep venous thrombosis (DVT) with iliac vein compression syndrome（IVCS）. MethodsBetween January 2021 and October 2023, a total of 64 patients with acute lower extremity DVT which performed AngioJet thrombectomy combined with iliac vein stenting in Weifang People’s Hospital were retrospectively analyzed. The changes of clinical symptoms, signs, and thrombus burden before and after operation were observed. The patency score of vein and stent, difference of thigh circumference and calf circumference diameter, venous clinical severity score (VCSS), and chronic venous insufficienc questionnaire-14item (CIVIQ-14) score were recorded pre- and postsurgically, and the patency of stent was statistically evaluated by a comprehensive assessment of the postoperative 12-month angiography. ResultsOperative success was achieved in all the 64 patients. The aspiration time was 300–480 s [(313±32) s], and the operative time was 80–120 min [ (97±21) min]. No complications such as bleeding and hematoma occurred after operation. The hospitalization time was 5–12 d [ (7.5±2.8) d]. After operation, the patency score of vein and stent and the difference of thigh circumference diameter decreased or reduced, and the difference were statistically significant (P<0.001). The score of VCSS decreased, score of CIVIQ-14 increased after operation (P<0.05). Color Doppler ultrasound was performed at the first, third and sixth months after operation, and anterograde venography of lower limbs was performed at the 12th month. Only one patient had thrombosis recurrence at one month after operation, and finally developed into post-thrombosis syndrome of deep veins of lower limbs after anticoagulant conservative treatment. The veins and stents of the rest patients were unobstructed. ConclusionAngioJet thrombectomy combined with iliac vein stenting, could effectively expedited clot removal, reduced limb swelling, prevented post-thrombotic syndrome recurrence and significantly improved quality of life for patients with acute lower extremity DVT.