Diagnosis And Treatment Of Varicose Veins Of Lower Extremities Combined With Non-thrombotic Iliac Vein Compression Syndrome

Object:To explore the minimally invasive treatment of varicose veins of the lower extremities(vvle)with non-thrombotic iliac vein compression syndrome(NIVCS),To confirm the necessity of pretreatment of iliac vein occlusion or stenosis and the effectiveness of laser combined with sclerotherapy in minimally invasive treatment of VVLE.Methods:From September 2017 to September 2019,patients Hospitalized in vascular surgery,Jinan Central Hospital with varicose veins of the lower extremities(VVLE)and non-thrombotic iliac vein compression syndrome(NIVCS)were analyzed retrospectively,and they were set as experimental group(group A).They were treated with Iliac vein stent implantation after Treatment of VVLE by endovenous laser treatment(EVLT)combined with sclerosing foam.Under the strictly controlling of the basic variables such as sex,BMI,age and working nature,66 patients with simple primary varicose veins(vvle)in the same period were matched as the proportion of 1:2,which was set as the control group(group B).Group B’s patients were treated with EVLT combined with sclerosing foam during hospitalization.All of the patients were followed up at one week,one month,three months and half a year after operation,with the help of ultrasonic examination in the outpatient Department.Depending on the symptoms and signs,the patients were graded by the clinical classification of CEAP.A telephone call or questionnaire survey was conducted during the period from hospitalization to follow-up visits.All patients in the experimental group and the control group were scored according to the venous clinical severity score(VCSS),so that we can get the score and difference of VCSS before and after operation to evaluate the effect of the treatment.Results:1.Basic characteristics of patients’ general information.There were no significant difference in gender distribution,age structure,body mass index(BMI)and preoperative CEAP score(P value<0.05).In addition,the risk factor of standing or sitting time was also controlled and matched as independent variable,with no significant difference between Group A and Group B(P value<0.05).2.Anterograde Venography of lower extremity.Before operation,all patients were reviewd by anterograde venography,including 640 cases of the left lower extremity venography in the preliminary screening.Results 57.1%of the patients had simple primary varicosis of great saphenous vein;8.0%of them were Simple varicose saphenous vein;21.8%had the great saphenous varices combined with small saphenous varices;5.1%were combined with the return blood of perforating veins;VVLE combined with NIVCS accounted for 5.3%,while post-thrombotic syndrome was 2.2%and the indolent DVT was 0.3%;Besides,one case of K-T syndrome was found,accounting for 0.1%.There was no serious contrast agent allergy.3.VCSS score and Difference value of the VCSSVCSS score:The patients’ data were gatherd to get the VCSS during the follow-up.There was no significant difference between group A and group B before operation(P value<0.05).There was significant difference in VCSS at 1 week,1 month and 3 months after operation(P value<0.05);D-value of the VCSS score:There was a significant difference between group A and group B one week after operation(P value<0.01),no statistical difference was found in half a year after operation(P=0.052).4.Recanalization of main and branch veins after operation.After the occurrence of such events,clinical intervention is needed in order to reseal the veins.Therefore,we used the cumulative rate index to calculate the half year postoperative recanalization rate.The cumulative incidence of trunk recanalization was 1/33 in the experimental group and 7/66 in the control group,with no statistical difference(P=0.192);The cumulative incidence of branch recanalization was 4/33 in the experimental group and 15/66 in the control group(P=0.207).We combined the frequency of the two reconnection events to improve the positive rate.There was no statistical difference between group A and group B.However,After patients were stratified according to their CEAP scores,we found that there was no significant difference in recanalization events between patients with mild(ceap2-3)and moderate(4)CEAP scores,while the incidence of control group which CEAP graded as severe(ceap5-6)with recanalization increased(13/66)was higher than that of experimental group(2/33),following a significant difference(P=0.025).5.Postoperative complications.No serious complications occurred in the experimental group and the control group,Such as pulmonary embolism,iliac vein rupture,etc.According to the chi square test between two groups,we found the statistical differences of 6 kinds of symptoms like Edema,leg pain,liposclerosis,ulcer,pigmentation,inflammation(P<0.05).The treatment of the experimental group could significantly improve the incidence of various postoperative adverse symptoms,which confirms the necessity of pretreatment of iliac vein occlusion or stenosis.Conclusion.1.Anterograde Venography of the lower extremity is a simple,time-consuming and safe examination.It can make a better evaluation of the scope and degree of lower extremity venous disease as well as hemodynamic changes.For example,it provides us for the patency of the vein,the shape and function of the valve and the function of the valve of the perforating branch.Therefore,it can be used as the first choice in the differential diagnosis of varicose veins and other diseases,which is meaningful to identify the etiology and assist the surgical operation.2.For iliac vein compression with clear indication of operation,intervention should be taken actively to relieve deep vein hypertension,As shown in Group B,pretreatment of iliac vein compression could significantly improve the prognosis of VVLE.3.It is safe and effective to treat VVLE with laser and sclerosing foams with a low incidence of postoperative complications.It is essential to insist on a continuous postoperative follow-up.