腔内治疗在下肢深静脉血栓后综合征中的疗效观察

Efficacy Observation of Endovascular Therapy for Post-Thrombotic Syndrome in the Lower Extremities

摘要: 目的：探讨血管腔内治疗在下肢深静脉血栓后综合征中的中远期效果。方法：回顾性分析2022年9月至2025年6月在青岛大学附属医院血管外科接受经皮介入的下肢深静脉血栓后综合征的116例患者，收集患者的一般临床资料，并根据接受的治疗方式将其分为下肢静脉单纯球囊扩张成形术组(PTA组)和下肢静脉支架置入术组(STENT组)。评估2组患者术前及术后的临床症状和体征改善情况，统计分析随访期间肢体症状改善程度及血管通畅率的差异，并进一步探讨血管腔内治疗对深静脉瓣膜功能的影响。结果：2组手术技术成功率均为100%；围术期并发症发生率差异无统计学意义(P = 0.794)；2组在病变节段分布差异无统计学意义(P > 0.05)，但PTA组左、右股静脉及多节段病变更为常见；PTA组TLR发生率明显高于STENT组，且多集中于术后6~12个月，与弹性回缩及残余狭窄有关，STENT组早期的TLR发生主要与轻中度ISR或血栓形成相关；2组术后CEAP与Villalta评分均较术前显著下降，提示症状均获得改善，但术后12和24个月STENT组改善幅度更大(均P < 0.05)；术前2组瓣膜反流参数无差异，随访6和12个月均呈改善趋势，但PTA组与STENT组之间无显著差异(P > 0.05)。结论：PTA与STENT均能改善PTS患者症状，但STENT在维持长期通畅、降低再干预率及稳定症状改善方面更具优势。

Abstract: Objective: Evaluation of Mid- to Long-Term Efficacy of Endovascular Therapy for Post-Thrombotic Syndrome in the Lower Extremities. Methods: This study was a single-center, retrospective analysis of 116 patients with lower extremity deep vein post-thrombotic syndrome (PTS) who underwent percutaneous endovascular intervention in the Department of Vascular Surgery at Affiliated Hospital of Qingdao University from September 2022 to June 2025. Results: The technical success rate was 100% in both groups, and there was no statistically significant difference in the rate of perioperative complications (P = 0.794). Regarding baseline anatomical characteristics, while there was no significant difference in the overall lesion segment distribution (P > 0.05), the PTA group presented with more frequent involvement of the left and right femoral veins and multi-segmental lesions. The Target Lesion Revascularization (TLR) rate was significantly higher in the PTA group compared to the STENT group. PTA failures were mainly concentrated between 6 and 12 months post-procedure, primarily attributed to elastic recoil and residual stenosis. Conversely, early TLR events in the STENT group were mainly associated with mild-to-moderate in-stent restenosis (ISR) or thrombosis. Both groups achieved a significant reduction in CEAP and Villalta scores postoperatively, indicating universal clinical symptom improvement. Crucially, the STENT group showed a greater magnitude of clinical improvement at 12 and 24 months compared to the PTA group (all P < 0.05). Furthermore, although pre-operative venous valve reflux parameters were similar and both groups demonstrated an improving trend at 6 and 12 months of follow-up, no significant difference in valve function parameters was observed between the PTA and STENT groups (P > 0.05). Conclusion: Both PTA and STENT treatments are effective in improving symptoms for Post-Thrombotic Syndrome (PTS) patients, but STENT holds a greater advantage in maintaining long-term patency, reducing reintervention rates, and providing stable symptom improvement.