To assess the first results of hybrid operations in chronic venous obstructions of iliofemoral segments in patients with postthrombotic syndrome (PTS).
Methods:
Hybrid operations (open endovenectomy from the common femoral vein with arteriovenous fistula creation and iliac vein stenting) were performed in 12 patients diagnosed with PTS. All of the patients were diagnosed with severe chronic venous insufficiency. The degree of manifestations of PTS was assessed by means of the Villalta score 7 months before and after the surgical intervention. Diagnostic methods of study included ultrasound duplex scanning, magnetic resonance and/or multispiral computed venography, and contrast venography.
Results:
Technical success of the procedure was 92%. The outcomes of hybrid operations after 7 months were followed up in 6 patients and in 4 patients in 3 months. Secondary patency rates of the stented iliac veins amounted to 100%. No recurrences of venous ulcers were observed. Median Villalta scores improved from 15 to 7 (P = .012).
Conclusion:
The first experience of hybrid operations for obstructive lesions of veins of the iliofemoral segments demonstrated their high efficacy and safety.
CoiteuxIMazzolaiL. Deep venous thrombosis: epidemiology, risk factors and natural history. Schweiz Rundsch Med Prax. 2006;95(12):455–459.
2.
HolperPKotelisDAttigahNHyhlik-Dürr, BöcklerD. Long-term results after surgical thrombectomy and simultaneous stenting for symptomatic iliofemoral venous thrombosis. Eur J Vasc Endovasc Surg. 2010;39(3):349–355.
3.
JohnsonBFManzoRABergelinROStrandnessDE. Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one-to-six year follow-up. J Vasc Surg. 1995;21(2):307–312.
4.
AkessonHBrudinLDahlströmJAEklöfBOhlinPPlateG. Venous function assessed during 5-year period ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg. 1990;4(1):43–48.
5.
MewissenMWSeabrookGRMeissnerMHCynamonJLabropoulosNHaughtonSH. Catheter directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology. 1999;211(1):39–49.
6.
Colledge-SmithPD. The aethiology and pathophysiology of chronic venous insufficiency and leg ulcers. In: JohnsonCDTaylorI, eds. Recent advances in surgery. Edinburg, TX: Churchill Livingstone; 2000:125–140.
7.
MoffatCJDormanMC. Recurrence of leg ulcers within a community ulcer service. J Wound care. 1995;4(2):57–61.
8.
RajuSNeglenP. Percutaneous recanalization of total occlusion of the iliac vein. J Vasc Surg. 2009;50(2):360–368.
9.
NeglenP. Endovascular reconstruction for chronic iliofemoral vein obstruction. In: GloviczkiP, ed. Handbook of Venous Disorders. 3rd ed. London, United Kingdom: Hodder Arnold; 2009:491–502.
10.
KahnSRComerotaAJCushmanM. American Heart Association Council on Peripheral Vascular Disease, Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing. The postthrombotic syndrome: evidence based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2014;130(18):1636–1661.
11.
WittensCDaviesAHBækgaardN. Management of chronic venous disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737.
ComerotaAJ.GrewalNKThakurSAssiZ. Endovenectomy of the common femoral vein and intraoperative iliac vein recanalization for chronic iliofemoral venous occlusion. J Vasc Surg. 2010;52(1):243–247.
14.
VogelDComerotaAJAl-JabouriMAssiZI. Common femoral endovenectomy with iliocaval endoluminal recanalization improves symptoms and quality of life in patients with postthrombotic iliofemoral obstruction. J Vasc Surg. 2012;55(1):129–135.
15.
NeglenPTackettTPRajuS. Venous stenting across the inguinal ligament. J Vasc Surg. 2008;48(5):1255–1261.
16.
GloviczkiPChoJS. Surgical treatment of chronic deep venous obstruction. In: RutherfordRB, ed. Vascular surgery. 5th edn. New York, NY: Elsevier; 2001:2099–2165.
17.
PuggioniAKistnerRLEklofBoLurieF. Surgical disobliteration of postthrombotic deep veins—endophlebectomy—is feasible. J Vasc Surg. 2004;39(5):1048–1052.
18.
ComerotaAJ. Common femoral endovenectomy and endoluminal recanalization for chronic postthrombotic iliofemoral venous obstruction. In: ComerotaAJKabnickSLSadickNS, eds. Deep vein thrombosis. Boca Raton, FL: CRC Press; 2014:115–123.
19.
KurstjensRLde GraafRBarbatiME. Arteriovenous fistula geometry in hybrid recanalisation of post-thrombotic venous obstruction. Phlebology. 2015;30(suppl 1):42–49.
20.
KahnSR. Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome. J Thromb Haemost. 2009;7(5):884–888.
De WolfMAArnoldussenCWWittensCH. Indications for endophlebectomy and/or arteriovenous fistula after stenting. Phlebology. 2013;28(suppl 1):123–128.
26.
AscherEMarksNHingoraniABlumbergSRizviA. The Bulls-Eye sign and other iliocaval-femoral venographic findings: a new classification to limit the use of the use of intravascular ultrasound. VEITHsymposium On-Demand 2016 Catalog. Available from: https://www.veithondemand.com/2016/catalog.php.
