背景：本文的总体目标是提供高水平的，在澳大利亚和新西兰（ANZ）管理静脉流出梗阻（VOO）的实用方法方法：一组来自ANZSVS的血管外科医生，特别感兴趣，培训,并调查了VOO的管理经验，以评估当前的本地实践。对结果进行了分析，并确定了分歧的领域。在此之后,该小组对主要国际组织发表的关于慢性静脉疾病管理的共识指南进行了文献综述,即血管外科学会(SVS)，美国静脉论坛（AVF），欧洲血管外科学会（ESVS），美国静脉和淋巴学会（AVLS），欧洲心血管和介入放射学学会（CIRSE）和美国心脏协会（AHA）。将这些准则与通过调查获得的共识声明进行了比较，以了解它们与ANZ实践的关系。此外,我们对选定的关键论文以及关于静脉支架置入术的综述和荟萃分析进行了讨论并添加到文件中.最后,投票通过了超过75%的陈述，并确定了指南适用性中的障碍。
结果：该文件涉及两个关键领域：患者选择和静脉支架置入术的技术方面。关于患者选择：CEAP评分3或以上的患者，VCSS疼痛评分2或以上或两者，静脉支架置入应考虑静脉造影/CTV/MRV/IVUS>50%狭窄的证据。建议IB水平；接受血栓清除治疗的急性髂股DVT患者，在他身上发现了罪魁祸首的狭窄病变，应考虑静脉支架置入术。建议IB水平；慢性盆腔疼痛患者，深度性交困难,性交后疼痛影响生活质量，当其他原因被排除时，应考虑静脉支架置入术。推荐IC级别。无症状患者不应进行静脉支架置入。推荐水平IIIC结论：患有深静脉流出道梗阻的患者几十年来一直未被诊断和治疗不足，但近年来，医生和行业的兴趣大幅增长。更简单，更安全的治疗方案的出现彻底改变了其管理，但不幸的是,静脉疾病的正规培训并没有以同样的速度增长。简化所需的技术和培训可能会导致结果不一致。这些准则旨在制定护理标准，并将作为未来发展的教育平台。
The overall goal of this report is to provide a high-level, practical approach to managing venous outflow obstruction (VOO) in Australia and New Zealand.
A group of vascular surgeons from the Australian and New Zealand Society for Vascular Surgery with specific interest, training, and experience in the management of VOO were surveyed to assess current local practice. The results were analyzed and areas of disagreement identified. Following this, the group performed a literature review of
consensus guidelines published by leading international organizations focused on the management of chronic venous disease, namely the Society for Vascular Surgery, American Venous Forum, European Society for Vascular Surgery, American Vein and Lymphatic Society, Cardiovascular and Interventional Radiology Society of Europe, and American Heart Association. These
guidelines were compared against the
consensus statements obtained through the surveys to determine how they relate to Australian and New Zealand practice. In addition, selected key studies, reviews, and meta-analyses on venous stenting were discussed and added to the document. Finally, a selection of statements with >75% agreement was voted on, and barriers to the
guideline\'s applicability were identified.
The document addresses two key areas: patient selection and technical aspects of venous stenting. Regarding patient selection, patients with a CEAP (Clinical-Etiologic-Anatomic-Physiologic) score of ≥3 or a venous clinical severity score for pain of ≥2, or both, and evidence of >50% stenosis on venography, computed tomography venography, magnetic resonance venography, and/or intravascular ultrasound should be considered for venous stenting (level of recommendation Ib) Patients undergoing thrombus removal for acute iliofemoral deep vein thrombosis, in whom a culprit stenotic lesion has been uncovered, should be considered for venous stenting (level of recommendation Ib). Patients with chronic pelvic pain, deep dyspareunia, postcoital pain affecting their quality of life, when other causes have been ruled out, should be considered for venous stenting (level of recommendation Ic). Asymptomatic patients should not be offered venous stenting (level of recommendation IIIc).
Patients with deep VOO have been underdiagnosed and undertreated for decades; however, in recent years, interest from physicians and industry has grown substantially. The advent of simpler and safer treatment options has revolutionized its management, but, unfortunately, formal training for venous disease has not grown at the same rate. Simplifying the technology and training required can result in inconsistent outcomes. These
guidelines are aimed at developing standards of care and will serve as an educational platform for future developments.
