混合入路治疗锁骨下静脉血栓形成的单中心经验

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques Pub Date : 2025-04-09 DOI:10.1016/j.jvscit.2025.101797

Maksym Katelenets MD, Victor Ginzburg MD, Anatoly Leytzin MD, Dmitry Shepovalov MD, Abu Kush Nahel MD, George Greenberg MD

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引用次数: 0

摘要

目的锁骨下静脉（SCV）血栓形成是上肢深静脉血栓形成的主要形式之一，在静脉胸廓出口综合征中起主导作用。这种情况主要影响年轻人和活跃的人，可导致四肢功能恶化和长期后果。尽管具有明显的临床重要性，但关于最佳治疗方法尚无共识或公认的方案。本研究的主要目的是介绍我们的局部治疗方案，并评估其有效性、安全性和功能影响。方法对2005年9月至2022年12月在我科住院治疗的27例心力SCV血栓患者进行单中心回顾性分析。中位随访时间为92个月（范围6-140个月）。采用Villalta评分和QuickDASH-9问卷进行支架早期和晚期通畅度评估和慢性静脉功能不全评估。结果在这27例患者中，23例采用导管溶栓、第一肋骨切除术，随后使用自膨胀支架对SCV进行血管内修复。18例患者进行静脉通畅评估，早期通畅率为94.4%，晚期通畅率为83.3%。发现4个支架闭塞。所有接受治疗的患者均未出现临床上显著的慢性静脉功能不全，中位Villalta评分为1分。QuickDASH-9问卷测量的手臂功能状态中位数为2.75。结论第一肋骨切除术是治疗方法的重要组成部分，在解除SCV的慢性骨压迫方面具有突出作用。随后的血管内修复达到不受影响的进展血流和良好的长期静脉通畅。尽管手术具有侵略性，但目前的方法在受影响肢体的安全性和功能状态方面显示出有希望的结果。

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Single-center experience in hybrid approach for subclavian vein effort thrombosis

Objective

Effort thrombosis of the subclavian vein (SCV) is one of the forms of deep vein thrombosis in the upper extremity and plays the leading role in venous thoracic outlet syndrome. This condition affects predominantly young and active people and can lead to extremity functional deterioration and long-term consequences. Despite the apparent clinical importance, no consensus or accepted protocol regarding optimal treatment exists. The main aim of this study was to present our local treatment protocol and to assess its effectiveness, safety, and functional impact.

Methods

We conducted a single-center retrospective analysis of 27 patients hospitalized and treated in our department with effort SCV thrombosis from September 2005 to December 2022. The median length of follow-up was 92 months (range, 6-140 months). Evaluation of early and late stent patency and the assessment of chronic venous insufficiency, using the Villalta score and arm functional status using the QuickDASH-9 questionnaire, were performed.

Results

Of these 27 patients, 23 were treated using catheter-directed thrombolysis, first rib resection with subsequent endovascular repair of the SCV using a self-expanding stent. A total of 18 patients were assessed for vein patency and showed an early patency of 94.4% and a late patency of 83.3%. Four stents were found to be occluded. None of the treated patients has developed clinically significant chronic venous insufficiency, and the median Villalta score was 1 point. The median functional status of the arm measured by the QuickDASH-9 questionnaire was 2.75.

Conclusions

First rib resection is an integral part of the treatment approach and is prominent in releasing chronic bony compression of the SCV. Subsequent endovascular repair achieves unaffected prograde flow and excellent long-term vein patency. Despite surgical aggressiveness, the current approach shows promising results in the context of the safety and functional status of the affected limb.

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来源期刊

Journal of Vascular Surgery Cases Innovations and Techniques SURGERY-

CiteScore

1.00

自引率

14.30%

发文量

219

审稿时长

29 weeks

期刊介绍： Journal of Vascular Surgery Cases and Innovative Techniques is a surgical journal dedicated to publishing peer review high quality case reports, vascular images and innovative techniques related to all aspects of arterial, venous, and lymphatic diseases and disorders, including vascular trauma, malformations, wound care and the placement and maintenance of arterio-venous dialysis accesses with an emphasis on the practicing clinician. The Journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals involved with the management of patients with the entire spectrum of vascular disorders.