髂静脉压迫综合征腔内干预决策的评估依据与研究进展

Assessment basis and research progress on decision-making for endovascular intervention in iliac vein compression syndrome

摘要:

髂静脉压迫综合征（IVCS）是慢性静脉疾病的重要病因之一，而如何从广泛存在的解剖性压迫中识别出真正需要腔内干预的患者，是当前临床管理的关键问题。本文系统综述了IVCS影像学诊断技术的发展，包括彩色多普勒超声、CT静脉成像、静脉造影及血管内超声（IVUS）等检查方法，并比较其适用场景及局限性。结合近年来临床研究，重点总结了支持腔内干预的循证依据，包括严重慢性静脉功能不全患者的临床获益、IVUS量化阈值在干预决策中的应用、复发性静脉曲张患者中IVCS的高发生率，以及髂静脉压迫作为深静脉血栓形成解剖学易感因素的重要意义。同时，对侧支循环代偿充分患者可采取保守治疗、重度狭窄患者支架远期疗效受限，以及功能性血流参数在干预决策中的补充价值进行了分析。现有证据提示，仅依据解剖学狭窄程度决定是否干预存在一定局限性，症状分级、IVUS定量测量及功能性血流评价相结合的综合评估模式有望进一步提高干预决策的精准性。未来仍需开展高质量、多中心的前瞻性研究，以进一步优化IVCS的腔内干预指征。

Abstract:

Iliac vein compression syndrome (IVCS) is a major cause of chronic venous disease. However, distinguishing patients who truly require endovascular intervention from those with incidental anatomical compression remains a major challenge in clinical practice. This review systematically summarizes the advances in imaging modalities for the diagnosis of IVCS, including color Doppler ultrasonography, computed tomography venography (CTV), venography, and intravascular ultrasound (IVUS), with particular emphasis on their clinical applications and inherent limitations. Based on recent clinical evidence, the indications supporting endovascular intervention are comprehensively reviewed, including the clinical benefits in patients with severe chronic venous disease, the application of IVUS-derived quantitative thresholds in treatment decision-making, the high prevalence of IVCS among patients with recurrent varicose veins, and the pathophysiological significance of iliac vein compression as an anatomical predisposing factor for deep vein thrombosis. In addition, the rationale for conservative management in patients with well-developed collateral venous circulation, the limited long-term efficacy of stenting in patients with severe stenosis, and the complementary value of functional hemodynamic parameters in guiding treatment decisions are also discussed. Current evidence suggests that treatment decisions based solely on the degree of anatomical stenosis have inherent limitations. A comprehensive assessment integrating clinical symptom severity, quantitative IVUS measurements, and functional hemodynamic evaluation may improve the precision of patient selection for endovascular intervention. Nevertheless, high-quality multicenter prospective studies are still warranted to further optimize the indications for endovascular treatment in patients with IVCS.