目的:近年来静脉阻塞的血管内治疗有了明显的发展。最佳患者预后的最佳实践尚未建立,证据基础也很差。这项研究的目的是就下肢静脉流出道阻塞患者的管理标准达成共识。
方法:本研究以两轮德尔菲共识进行。关于成像的声明,症状和其他基线测量,鉴别诊断,治疗算法,支架植入的适应症,流入/流出评估,成功的程序性结果,术后治疗和支架监测,和临床成功因素。由6名专家医师(第1轮,40份陈述)和由24名医师组成的扩大小组(第2轮,80份陈述)编写陈述,并发送给符合资格标准的预先确定的静脉专家组。使用9点Likert量表,共识定义为≥70%的受访者将陈述评分在7至9(同意)或1至3(不同意)之间。第1轮结果用于指导第2轮的重新措辞和拆分复合陈述,以使第2轮更加清晰。
结果:在第1轮中,110位专家中有75位(68%)专家做出了回应,121位专家中有91位(75%)在第二轮中做出了回应。第一轮在32/40(80%)声明中达成共识。在治疗算法部分未达成共识。第二轮在50/80(62.5%)达成共识。达成共识的陈述是影像学(2/3,66%),症状和其他基线测量(12/24,50%),鉴别诊断(2/8,25%),治疗算法(10/17,59%),支架置入适应症(10/10,100%),流入/流出评估(2/2,100%),程序性结果(2/2,100%),术后治疗和支架监测,(5/7,71%),和临床成功因素(5/7,71%)。
结论:这项研究表明,在下肢静脉流出道阻塞的最佳管理方面,静脉专家达成了相当多的共识。有多个领域缺乏共识,突出需要进一步调查/研究的重要领域。
OBJECTIVE: The endovascular treatment of venous obstruction has expanded significantly in recent years. Best practices for optimal patient outcomes are not well established and the evidence base is poor. The purpose of this study was to obtain
consensus on management criteria for patients with lower extremity venous outflow obstruction.
METHODS: The study was conducted as a two round Delphi
consensus. Statements addressed imaging, symptoms and other baseline measures, differential diagnosis, treatment algorithm, indications for stenting, inflow and outflow assessment, successful procedural outcomes, post-procedure therapies and stent surveillance, and clinical success factors. Statements were prepared by six expert physicians (round 1, 40 statements) and an expanded panel of 24 physicians (round 2, 80 statements) and sent to a pre-identified group of venous experts who met qualifying criteria. A 9 point Likert scale was used and consensus was defined as ≥ 70% of respondents rating a statement between 7 and 9 (agreement) or between 1 and 3 (disagreement). Round 1 results were used to guide rewording and splitting compound statements for greater clarity in round 2.
RESULTS: In round 1, 75 of 110 (68%) experts responded, and 91 of 121 (75%) experts responded in round 2. Round 1 achieved
consensus in 32/40 (80%) statements.
Consensus was not reached in the treatment algorithm section. Round 2 achieved
consensus in 50/80 (62.5%). Statements reaching consensus were imaging (2/3, 66%), symptoms and other baseline measures (12/24, 50%), differential diagnosis (2/8, 25%), treatment algorithm (10/17, 59%), indications for stenting (10/10, 100%), inflow and outflow assessment (2/2, 100%), procedural outcomes (2/2, 100%), post-procedure therapies and stent surveillance, (5/7, 71%), and clinical success factors (5/7, 71%).
CONCLUSIONS: This study demonstrated that considerable consensus was achieved between venous experts on the optimal management of lower extremity venous outflow obstruction. There were multiple domains where consensus is lacking, highlighting important areas for further investigation and research.