背景:深静脉血栓形成(DVT)构成了复杂的挑战,通常会导致血栓形成后综合征(PTS),使人衰弱的并发症。静脉支架的出现提供了预防这种并发症的潜在途径。本研究旨在为静脉支架治疗DVT提供共识建议。
方法:从2023年6月到7月,20内科,血管和血管外科,血管和介入放射学专家参与了德尔菲过程。31条建议,分为三个主题领域,进行了严格的评估:支架使用的适应症,支架的选择和放置,监测和预防并发症。协议是用李克特量表评估的,三分之二的参与者达成共识。
结果:31项建议中有23项(74.2%)达成共识。协议以考虑为中心,例如在特定急性DVT情况下放置支架,强调关键的支架特性。然而,根据髂血管分叉形态,为防止迁移而推荐的支架长度和支架特性存在差异.值得注意的是,对于由主要短暂性危险因素引起的DVT患者是否需要3个月以上的抗凝治疗,或者静脉支架置入后是否应在抗凝治疗中加入阿司匹林,目前尚无共识.
结论:这些共识建议为优化静脉支架使用以预防DVT患者的PTS提供了实用见解。解决支架选择的关键方面,placement,和术后护理,这些建议有助于临床决策.查明的分歧强调了共识的重要性,因此表明需要进一步调查。
BACKGROUND: Deep vein thrombosis (DVT) poses a complex challenge and often leads to postthrombotic syndrome (PTS), a debilitating complication. The emergence of venous stents offers a potential preventive avenue against this complication. This study aimed to provide
consensus recommendations on the use of venous stent for DVT.
METHODS: From June to July 2023, 20 internal medicine, angiology and vascular surgery, and vascular and interventional radiology experts were involved in the Delphi process. Thirty-one recommendations, categorized into three thematic areas, were rigorously evaluated: indications for stent use, stent selection and placement, and monitoring and prevention of complications. Agreement was evaluated using a Likert scale, with
consensus defined as agreement by two-thirds of the participants.
RESULTS: Consensus was reached for 23 (74.2%) of 31 recommendations. The agreement was centered on considerations, such as stent placement in specific acute DVT scenarios, emphasizing pivotal stent characteristics. However, there were divergences in the recommended stent length to prevent migration and stent characteristics based on iliocaval bifurcation morphology. Notably, there was no
consensus on whether patients with DVT caused by a major transient risk factor need more than 3 months of anticoagulation therapy or whether aspirin should be added to anticoagulant treatment after venous stenting.
CONCLUSIONS: These
consensus recommendations offer practical insights into optimizing venous stent use to prevent PTS in DVT patients. Addressing the critical aspects of stent selection, placement, and postprocedural care, these recommendations contribute to clinical decision-making. The identified divergences underscore the importance of consensus and thus indicate the need for further investigation.