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Grøtta O, Enden T, Sandbæk G, Gjerdalen GF, Slagsvold CE, Bay D, Kløw NE, Rosales A. Infrainguinal inflow assessment and endovenous stent placement in iliofemoral post-thrombotic obstructions. CVIR Endovasc 2018; 1:29. [PMID: 30652160 PMCID: PMC6319667 DOI: 10.1186/s42155-018-0038-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/31/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess the technical success, patency, and clinical outcome, following assessment of inflow and infrainguinal endovenous stent placement in patients with iliofemoral post-thrombotic obstruction with infrainguinal involvement. Methods A retrospective analysis of 39 patients with iliofemoral post-thrombotic venous obstruction accepted for infrainguinal stent placement in the period November 2009–December 2016. The clinical status was categorized according to the Clinical Etiological Anatomical Pathophysiological (CEAP) classification and symptom severity was assessed using Venous Clinical Severity Score (VCSS). The inflow was categorized as “good”, “fair”, or “poor” depending on vein caliber and extent of post-thrombotic changes in the inflow vessel(s). Stent patency was assessed by duplex ultrasound. Median follow-up was 44 months (range 2–90 months). Results Stent placement was successful in all 39 patients. Primary patency after 24 months was 78%. Thirty of 39 patients (77%) had open stents at final follow-up. Re-interventions were performed in four patients and included catheter-directed thrombolysis (CDT) in all and adjunctive stenting in two. Twenty-eight of 39 patients (72%) reported a sustained clinical improvement. Patients with “good” inflow had better patency compared to those with “fair”/“poor” (p = 0.01). One patient experienced acute contralateral iliofemoral thrombosis; this segment was successfully treated with CDT and stenting. No other complications required intervention. Conclusion Infrainguinal endovenous stent placement was a feasible and safe treatment with good patency and clinical results, and should be considered in patients with substantial symptoms from post-thrombotic obstructions with infrainguinal involvement. Stents with good inflow have better patency and inflow assessment is essential in deciding the optimal stent landing zone.
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Affiliation(s)
- Ole Grøtta
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.,4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway
| | - Tone Enden
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Gunnar Sandbæk
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.,4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway
| | - Gard Filip Gjerdalen
- 3Section of Vascular Investigations, Department of Vascular Surgery, Oslo University Hospital Aker, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Carl-Erik Slagsvold
- 3Section of Vascular Investigations, Department of Vascular Surgery, Oslo University Hospital Aker, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Dag Bay
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Nils-Einar Kløw
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.,4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway
| | - Antonio Rosales
- 2Department of Vascular Surgery, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway
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Jayaraj A, Crim W, Knight A, Raju S. Characteristics and outcomes of stent occlusion after iliocaval stenting. J Vasc Surg Venous Lymphat Disord 2018; 7:56-64. [PMID: 30442577 DOI: 10.1016/j.jvsv.2018.07.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE With increasing use of iliocaval stenting, complications have become more noticeable. Stent occlusion is one such outcome that has not been studied in detail. Characteristics of stent occlusion in addition to outcomes after recanalization are presented. METHODS An analysis of 3468 initial iliocaval stents placed during an 18-year period from 1997 to 2015 was performed. A total of 102 stent occlusions were identified, amounting to a 3% stent occlusion rate. Characteristics evaluated included onset after stent placement, techniques used for restoring patency, and their outcome. Kaplan-Meier analysis was used to assess stent patency. Regression analysis was used to evaluate risk factors for stent occlusion. RESULTS Stent occlusions occurred at a median of 5.8 months after placement. The occluded stent could be reopened after a wide range of intervals, the longest being 14 years. The majority (69%) of occlusions were chronic (>30 days) and the remainder (31%) were acute; 77% of the occlusions occurred in post-thrombotic limbs. The most common technique used to recanalize the acutely occluded stent was pharmacomechanical thrombectomy, whereas wire recanalization with balloon angioplasty was the technique most used for chronic occlusions. Of the 102 occluded stents, patency was achieved in 75 of 88 (84%) attempts. After successful recanalization, the median primary patency was 7 ± 1.9 months, median primary assisted patency was 7.5 ± 3.5 months, and median secondary patency was 25 ± 8.3 months. Clinically, there was improvement in the visual analog scale pain scores from a median of 3.5 to 1 (P < .01), in the median grade of swelling from 2 to 1 (P < .01), and in the mean Venous Clinical Severity Score from 6.4 to 3.8 (P < .01) after recanalization. A 40% ulcer healing rate was noted after recanalization during a median follow-up period of 17 months. There were no significant adverse events or mortality. Regression analysis revealed stent placement for native vein occlusion as the only statistically significant predictor of stent occlusion. CONCLUSIONS Stent occlusion after iliocaval stenting is a rare occurrence. Recanalization of occluded stents can be performed with minimal morbidity even months to years after occlusion with good outcomes. Long-term patency of occluded stents that were recanalized is poor compared with patency of the initially placed stent.
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Affiliation(s)
- Arjun Jayaraj
- The RANE Center for Venous and Lymphatic Diseases, St. Dominic's Hospital, Jackson, Miss.
| | - William Crim
- The RANE Center for Venous and Lymphatic Diseases, St. Dominic's Hospital, Jackson, Miss
| | - Alexander Knight
- The RANE Center for Venous and Lymphatic Diseases, St. Dominic's Hospital, Jackson, Miss
| | - Seshadri Raju
- The RANE Center for Venous and Lymphatic Diseases, St. Dominic's Hospital, Jackson, Miss
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53
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Wadhwa V, Srinivasa RN, Cooper KJ, Hage AN, Bundy JJ, Spencer B, Vadlamudi V, Chick JFB. Endovascular Therapy for Lower Extremity Chronic Deep Venous Occlusive Disease: State of Practice. Semin Intervent Radiol 2018; 35:333-341. [PMID: 30402016 DOI: 10.1055/s-0038-1669963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Kyle J Cooper
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan.,Department of Radiology, Loma Linda University, Loma Linda, California
| | - Anthony N Hage
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Jacob J Bundy
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Brooke Spencer
- Minimally Invasive Procedure Specialists, Interventional Institute of Colorado, Parker, Colorado
| | - Venu Vadlamudi
- Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, Alexandria, Virginia
| | - Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan.,Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, Alexandria, Virginia
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Zamboni P, Giaquinta A, Rimondi E, Pedriali M, Scanziani E, Riccaboni P, Veroux M, Secchiero P, Veroux P. A novel endovenous scaffold for the treatment of chronic venous obstruction in a porcine model: Histological and ultrastructural assessment. Phlebology 2018; 34:336-346. [PMID: 30336762 DOI: 10.1177/0268355518805686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the biological effects of a novel endovenous scaffold in a porcine model. METHODS Petalo is a compliant venous scaffold implanted into the internal jugular veins of 12 healthy pigs. The pigs were sacrificed at one, two, three, and six months, respectively. Microscopic investigations were performed at two blinded laboratories. RESULTS Neo-intima formation progressively covering up the stent metallic bars was observed. The inflammatory response of the venous wall showed a peak after three months by the implant, followed by marked reduction after six months. The device induced a significant ( p < 0.01) increase of the thickness respect to the control regions, but was comparable in sections obtained after three and six months. CONCLUSIONS The implant of Petalo compliant venous scaffold in the venous wall of this porcine model is characterized by neointima formation and by an inflammatory reaction which tends to decrease after six months. Our data point against the induction of smooth muscle cells proliferation and migration as confirmed by electronic transmission microscopy analyses.
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Affiliation(s)
- Paolo Zamboni
- 1 Unit of Translational Surgery and Vascular Diseases Centre, University Hospital, Ferrara, Italy
| | - Alessia Giaquinta
- 2 Unit of Vascular and Transplantation Surgery, University of Catania, Catania, Italy
| | - Erika Rimondi
- 3 Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Massimo Pedriali
- 4 Morbid Anatomy Service, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Eugenio Scanziani
- 5 Department of Veterinary Sciences and Public Health, Azienda Polo Veterinario di Lodi, University of Milan, Italy
| | - Pietro Riccaboni
- 5 Department of Veterinary Sciences and Public Health, Azienda Polo Veterinario di Lodi, University of Milan, Italy
| | - Massimiliano Veroux
- 2 Unit of Vascular and Transplantation Surgery, University of Catania, Catania, Italy
| | - Paola Secchiero
- 3 Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Pierfrancesco Veroux
- 2 Unit of Vascular and Transplantation Surgery, University of Catania, Catania, Italy
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Lichtenberg M, Breuckmann F, Friedrich Stahlhoff W, Neglén P, de Graaf R. Placement of closed-cell designed venous stents in a mixed cohort of patients with chronic venous outflow obstructions – short-term safety, patency, and clinical outcomes. VASA 2018; 47:475-481. [DOI: 10.1024/0301-1526/a000731] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract. Background: To evaluate the performance of a closed-cell designed venous stent for the treatment of chronic ilio-femoral venous outflow obstruction (VOO) in the shortterm. Patients and methods: Safety, stent patency and clinical outcome after placement of the Vici Venous Stent® in patients with chronic ilio-femoral venous obstruction were assessed retrospectively. Stent patency was evaluated by duplex ultrasound scanning, and clinical outcome was determined using the revised Venous Clinical Severity score (rVCSS). Results: 75 patients (49 % female; median age 57 years; 82 limbs) with symptomatic significant VOO had stents placed in the ilio-femoral veins. Lower limb venous skin changes including ulcers (C-class in CEAP 4–6) were found in 31 patients (41 %). Nonthrombotic iliac vein lesions (NIVLs) and post-thrombotic obstruction (PTO) were found in 40 and 42 limbs, respectively. There were no safety issues. Cumulative primary, assisted-primary, and secondary stent patency in the entire cohort at 12 months were 94 %, 94 % and 96 %, respectively. Five limbs presented with stent occlusion. Two limbs had no intervention, 2/3 remained patent after reintervention. Clinical improvement (a decrease ≥ 2 rVCSS points) was observed in 81 %, 81 %, and 77 % of patients at 1 month, 6 months, and 12 months, respectively. There was a marked drop in the frequency of more marked pain and swelling (VCSS ≥ 2) from 62 % to 5 % and 93 % to 19 %, respectively. Four limbs had venous ulcers, three healed during the follow-up. Cumulative pri- mary stent patency at 12 months was 100 % and 87 % in patients with NIVL and PTO, respectively (p= 0.032). There was no statistical difference in clinical outcome between these subgroups. Conclusions: The Vici Venous Stent® placed in the ilio-femoral vein segment in patients with symptomatic VOO revealed no safety issues, had excellent primary patency and substantial symptom improvement. Long-term studies are needed to evaluate the durability of this stenting procedure.
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Affiliation(s)
| | | | | | - Peter Neglén
- Venous Centre, Klinikum Arnsberg GmbH, Arnsberg, Germany
| | - Rick de Graaf
- Venous Centre, Klinikum Arnsberg GmbH, Arnsberg, Germany
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56
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Black S, Gwozdz A, Karunanithy N, Silickas J, Breen K, Hunt B, Smith A, Cohen A, Saha P. Two Year Outcome After Chronic Iliac Vein Occlusion Recanalisation Using the Vici Venous Stent ®. Eur J Vasc Endovasc Surg 2018; 56:710-718. [PMID: 30139572 DOI: 10.1016/j.ejvs.2018.07.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE/BACKGROUND The aim was to assess two year outcomes with placement of the Vici Venous Stent® in patients with chronic iliofemoral venous occlusions (complete blockage). METHODS This was a retrospective single centre study comprising patients treated with the Vici Venous Stent for venographically verified iliofemoral venous occlusion and post-thrombotic syndrome (Villalta score ≥ 5 points) at least 12 months after acute deep vein thrombosis. Venography and intravascular ultrasound were used peri-operatively; duplex ultrasound was used to assess stent patency during follow up. RESULTS Eighty-eight patients (101 limbs) had stent placement between March 2014 and October 2016. Median pre-treatment Villalta score was 14 (range 5-33). Stenting extended across the inguinal ligament in 63 limbs (62%) in order to land in a healthy venous segment. Six patients (7%) required endophlebectomy and fistula creation. Median imaging follow up was 21 months (range 0-41 months). Primary, assisted primary and secondary patency rates at one year were 59%, 78%, and 87%, respectively, and two years 51%, 73%, and 82%, respectively. Forty-three limbs (43%) had re-intervention (lysis, venoplasty, and/or placement of stent) during follow up; median time to re-intervention was 32 days (range 0-520 days). At 24 months, 37 of 53 limbs (70%) with available Villalta assessment showed clinically significant improvement (>30% reduction of baseline score). Villalta scores at the 6, 12, and 24 month clinical follow up were significantly lower than before stenting (p < .001, all time points). In a subset analyses of limbs with stenting terminating above and below the inguinal ligament, secondary cumulative patency rates at 24 months were 90% and 79%, respectively; clinical outcome showed 58% vs. 73% of limbs with clinically significant improvement, respectively. There was no statistically significant difference in patency or clinical outcomes. CONCLUSION The Vici Venous Stent is associated with a good secondary patency rate and durable and substantial symptomatic resolution in patients with chronic post-thrombotic occlusions, regardless of whether stents extended beneath the inguinal ligament.
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Affiliation(s)
- Stephen Black
- Academic Department of Vascular Surgery, Guy's and St. Thomas' NHS Trust, King's College London, London, UK.
| | - Adam Gwozdz
- Academic Department of Vascular Surgery, Guy's and St. Thomas' NHS Trust, King's College London, London, UK
| | - Narayan Karunanithy
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Trust, London, UK
| | - Justinas Silickas
- Academic Department of Vascular Surgery, Guy's and St. Thomas' NHS Trust, King's College London, London, UK
| | - Karen Breen
- Thrombosis and Haemophilia Centre, Guy's and St. Thomas' NHS Trust, London, UK
| | - Beverley Hunt
- Thrombosis and Haemophilia Centre, Guy's and St. Thomas' NHS Trust, London, UK
| | - Alberto Smith
- Academic Department of Vascular Surgery, Guy's and St. Thomas' NHS Trust, King's College London, London, UK
| | - Ander Cohen
- Thrombosis and Haemophilia Centre, Guy's and St. Thomas' NHS Trust, London, UK
| | - Prakash Saha
- Academic Department of Vascular Surgery, Guy's and St. Thomas' NHS Trust, King's College London, London, UK
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57
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Rollo JC, Farley SM, Jimenez JC, Woo K, Lawrence PF, DeRubertis BG. Contemporary outcomes of elective iliocaval and infrainguinal venous intervention for post-thrombotic chronic venous occlusive disease. J Vasc Surg Venous Lymphat Disord 2018; 5:789-799. [PMID: 29037346 DOI: 10.1016/j.jvsv.2017.05.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/15/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients with iliofemoral deep venous thrombosis are at risk for development of post-thrombotic syndrome. Iliac vein stenting has been shown to significantly improve clinical outcomes in patients with venous outflow obstruction, although many studies include a heterogeneous population with several different venous pathologic processes. Our objective was to evaluate the results of iliocaval and infrainguinal venous intervention for venous outflow obstruction due to post-thrombotic chronic venous occlusive disease. METHODS All patients treated at a single institution for symptomatic iliocaval venous occlusive lesions with and without infrainguinal extension between 2008 and 2015 were retrospectively analyzed. Nonthrombotic iliac vein lesions were excluded from analysis. All patients with symptomatic post-thrombotic occlusion of the iliac vein or inferior vena cava (IVC) and a Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) score of 3 or greater were included. Demographics of the patients, presence of IVC filters at presentation, presenting CEAP score, postintervention CEAP score, primary and secondary patency, wound healing and subjective clinical improvement outcomes, and procedural details were recorded in a database. RESULTS There were 105 patients with symptomatic iliocaval venous occlusive lesions identified, of which 31 patients (42 limbs) met inclusion criteria. Presenting symptoms included pain or swelling (100%); venous claudication (81%); and CEAP class 3 (76%), 4 or 5 (14%), or 6 (10%). All patients presented with either subacute (>30 days [35%]) or chronic (>90 days [65%]) iliocaval venous thrombosis. Procedural technical success with venous recanalization was achieved in 100% of cases and in 46% of IVC filter retrieval attempts. Overall clinical improvement was achieved in 84% of patients; complete clinical resolution was obtained in 42% and a decrease in CEAP score in 65%. At a mean follow-up of 14.7 months (range, 2-49 months), primary and secondary 1-year patency was 66% and 75% overall, and primary patency was equivalent between patients requiring isolated iliac venous stenting and those requiring infrainguinal stent extension (68% vs 65%, respectively; P = .74, not significant). Patients who presented with IVC filters had a higher rate of complete clinical resolution if the filter could be removed (100%) compared with those patients in whom the filter could not be removed (17%; P < .01). CONCLUSIONS Treatment of chronic venous occlusive disease with iliocaval and infrainguinal venous stenting is associated with acceptable 1-year patency rates, healing of venous ulcers, and a significant reduction in symptoms and CEAP score. Patients who underwent successful removal of indwelling IVC filters showed improved clinical outcomes compared with those in whom the IVC filter could not be removed.
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Affiliation(s)
- Johnathon C Rollo
- Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, Calif
| | - Steven M Farley
- Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, Calif
| | - Juan Carlos Jimenez
- Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, Calif
| | - Karen Woo
- Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, Calif
| | - Peter F Lawrence
- Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, Calif
| | - Brian G DeRubertis
- Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, Calif.
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Chick JFB, Srinivasa RN, Cooper KJ, Jairath N, Hage AN, Spencer B, Abramowitz SD. Endovascular Iliocaval Reconstruction for Chronic Iliocaval Thrombosis: The Data, Where We Are, and How It is Done. Tech Vasc Interv Radiol 2018; 21:92-104. [DOI: 10.1053/j.tvir.2018.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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59
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Lichtenberg M, de Graaf R, Erbel C. Standards for recanalisation of chronic venous outflow obstructions. VASA 2018. [DOI: 10.1024/0301-1526/a000696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. Postthrombotic syndrome (PTS) is the most common complication after iliofemoral deep vein thrombosis. It reduces quality of life and increases deep vein thrombosis (DVT)-related costs. The clinical symptoms and severity of PTS may vary; the most common symptoms include edema, pain (venous claudication), hyperpigmentation, lipodermatosclerosis, and ulceration. PTS is based on the principle of outflow obstruction, which may be caused by venous hypertension and may lead to valvular damage and venous reflux or insufficiency. Recent technical developments and new stent techniques now allow recanalisation of even complex venous outflow obstructions within the iliac vein and the inferior vena cava. This manuscript gives an overview on the latest standards for venous recanalisation.
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Affiliation(s)
| | - Rick de Graaf
- Klinikum Arnsberg GmbH, Karolinen-Hospital, Arnsberg-Hüsten, Germany
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60
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van Vuuren T, Wittens C, de Graaf R. Stent Extension below the Common Femoral Vein in Extensive Chronic Iliofemoral Venous Obstructions. J Vasc Interv Radiol 2018; 29:1142-1147. [PMID: 29803717 DOI: 10.1016/j.jvir.2018.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To analyze whether primary venous stent placement into 1 dominant inflow vein peripheral to the common femoral vein (CFV) confluence is feasible. MATERIALS AND METHODS Retrospective review was performed of 14 consecutive patients who underwent primary venous stent placement into veins peripheral to the CFV between 2013 and 2016. Mean patient age was 49 years; 6 (43%) patients were women. All patients had successful deep venous stent placement with brisk contrast flow through the stent. Patients had primary percutaneous stent placement when postthrombotic changes extended peripherally to the femoral confluence but a trabeculation-free area in the deep femoral vein (DFV) could be identified. Based on imaging findings, the DFV had to be considered the prominent inflow vein with normal anatomy. Femoral vein, DFV, and collateral inflow were minimally impaired owing to postthrombotic scarring or trabeculations. RESULTS Primary, assisted primary, and secondary patency rates were 92% at a median follow-up of 481 d (range, 411-792 d). Venous Clinical Severity Score decreased from a mean of 8.9 to 6.4 (P = .03). The Villalta scale decreased from a mean of 11.7 to 4.3 (P = .003). Before intervention, venous claudication was present in 92% and remained in 38% after intervention (P = .016). CONCLUSIONS Stent placement through the femoral confluence into a dominant inflow vein is a promising option in a carefully selected group of patients.
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Affiliation(s)
- Timme van Vuuren
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands.
| | - Cee Wittens
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands; Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Rick de Graaf
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, Netherlands
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61
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Souto Barros F, Salles-Cunha SX, Roelke LH, Morais Filho DD, Paula Brandão NAD, Pontes SM. Arterial Compression of Left Iliac Veins: Five-Year Patency Rates of Endovascular Treatment. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1544316718763388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Endovascular angioplasty and stenting have become a treatment of choice for severely symptomatic left iliac veins under external, arterial compression. Patency rates of stented iliac veins based on ultrasonographic (US) findings were estimated. Retrospective analyses of gender, age, deep venous thrombosis (DVT) prior to stenting, stent location at common and/or external iliac veins, and patency rates from 1 month to 5 years were performed. Patients treated were mostly women (72 of 79, 91%), aged 51 ± 16 (25-89) years. Patency rates were 96% at 1 month, 89% at 1 year, and 85% at 3 to 5 years, best for common iliac, 95%, than for external iliac vein stents, subgroup with prior DVT, with secondary patency rates of 75%. US demonstrated acceptable patency rates for iliac vein stenting showing good performance for common iliac vein stents but a decreased performance with stent extending to the external iliac vein or stents placed in patients with prior iliac DVT.
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Abstract
Chronic deep vein thrombosis (DVT) affects hundreds of thousands of women in the United States. Chronic DVT can lead to pain, edema, venous ulcers, and varicosities. While there are limited data regarding the management of chronic DVT, several interventional radiology groups aggressively treat chronic DVT to aid patient symptom resolution. Recanalization of occluded veins and venous stenting re-establishes deep vein flow and decreases venous hypertension.
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Affiliation(s)
- Rulon L Hardman
- Section of Interventional Radiology, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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63
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van Vuuren TM, Doganci S, Toonder IM, Graaf RD, Wittens CH. Venous stent patency may be affected by collateral vein lumen size. Phlebology 2018. [PMID: 29514565 PMCID: PMC6348454 DOI: 10.1177/0268355518755959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Deep venous thrombosis causes blood flow deviation. It is hypothesized that with stent placement, developed collateral veins become redundant. This article evaluates the relation between the surface area of the collaterals and stent patency. Methods The azygos and hemiazygos veins were identified and the largest surface area was measured at thoracic level. Patency rates of stented tracts were evaluated and related to collateral vein lumen size. Results The vena cava occlusion and the azygos and hemiazygos vein surface area measurements were positive and statistically significant related (OR 1.01, 95% CI 1.003−1.019, p = 0.004) respectively (and OR 1.007, 95% CI 1.001−1.013, p = 0.004). An azygos surface area measurement of 23 (p<0.001) and hemiazygos surface area measurement of 40 (p = 0.008) was shown as cut-off point related to higher occlusion rates. Conclusions The surface area of major venous collateral pathways seems to be related to stent occlusion in deep venous interventions.
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Affiliation(s)
- Timme Maj van Vuuren
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Suat Doganci
- 3 Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey
| | - Irwin M Toonder
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,4 Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Rick De Graaf
- 5 Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cees Ha Wittens
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,4 Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Stuck AK, Reich T, Engelberger RP, Sebastian T, Kucher N. Endovascular treatment of post-thrombotic and non-thrombotic iliofemoral venous outflow obstructions with self-expanding nitinol stents. VASA 2018; 47:319-325. [PMID: 29512422 DOI: 10.1024/0301-1526/a000697] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of the study was to investigate venous patency and clinical outcomes for endovascular treatment of iliofemoral venous obstruction in patients with post-thrombotic syndrome (PTS) and non-thrombotic iliac vein lesion (NIVL) with dedicated self-expanding nitinol stents. PATIENTS AND METHODS Data were collected from the prospective Swiss Venous Stent Registry, enrolling consecutive patients with a standardized follow-up procedure since January 2008. Patency was evaluated by duplex sonography and clinical outcome by various scores including the Villalta score at baseline, three, six, and 12 months, and then annually after endovascular therapy. RESULTS Overall, 93 patients (64 PTS, 29 NIVL) were analysed. Mean follow-up time was 20 ± 16 (range 3-70) months. A total of 11 (12 %) patients had a stent occlusion, all of which occurred in the PTS group, and 13 (14 %) patients had a symptomatic stent stenosis. Primary patency was 79 % (95 % CI 68-87 %) at 12 months and 72 % (95 % CI 59-82 %) at 24 months. In PTS patients, primary patency at 12 months was 75 % (95 % CI 61-84 %) vs. 89 % (95 % CI 63-97 %) in NIVL patients (p = 0.10). Secondary patency at 24 months was 94 % (95 % CI 84-98 %) in PTS and 100 % in NIVL, p = 0.19). Overall, 62 (67 %) patients were free from PTS at the latest follow-up with a Villalta score < 5 points. Predictive factors for the loss of primary patency were stents placed below the inguinal ligament (OR 2.59, 95 % CI, 0.99-6.84, p = 0.05). CONCLUSIONS In symptomatic patients with chronic iliofemoral vein obstruction, endovascular therapy with self-expanding nitinol stents was associated with favourable patency rates and clinical improvement in the majority of patients.
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Affiliation(s)
- Anna K Stuck
- 1 Department of Geriatrics, Inselspital, University Hospital, Bern, Switzerland
| | - Thomas Reich
- 2 University of Bern, Medical Faculty, Bern, Switzerland
| | - Rolf P Engelberger
- 3 Division of Angiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Tim Sebastian
- 4 Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Nils Kucher
- 4 Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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Razavi M, Marston W, Black S, Bentley D, Neglén P. The initial report on 1-year outcomes of the feasibility study of the VENITI VICI VENOUS STENT in symptomatic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord 2018; 6:192-200. [DOI: 10.1016/j.jvsv.2017.10.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022]
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Schleimer K, Barbati ME, Gombert A, Wienert V, Grommes J, Jalaie H. The Treatment of Post-Thrombotic Syndrome. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:863-870. [PMID: 28098065 DOI: 10.3238/arztebl.2016.0863] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 05/24/2016] [Accepted: 09/01/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) arises in 20-50% of patients who have sustained a deep vein thrombosis and markedly impairs their quality of life. METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed and the Cochrane Library, and on the guidelines of the German Societies of Phlebology and Vascular Surgery (Deutsche Gesellschaft für Phlebologie, Deutsche Gesellschaft für Gefässchirurgie). RESULTS The treatment options are conservative treatment with compression and patient exercises, endovascular recanalization with stent angioplasty, and open bypass surgery of the iliac obstructions. The endovascular techniques yield patency rates of 73 to 100%, with thrombotic stent occlusion and hematoma as potential complications. The open operations have only been documented in studies with small case numbers (3 to 85 cases per study, patency rates 58 to 100%). The complications of these invasive procedures can include thrombotic bypass occlusion, hematoma, and wound infection. There have been randomized trials of conservative treatment, but not of surgical treatment. The American Heart Association, in its guidelines, gives the same weak recommendation for all surgical methods (IIb). CONCLUSION All conservative options should be exhausted as the first line of treatment. If PTS symptoms persist and markedly impair the patient's quality of life, the possible indication for surgery should be considered. As PTS hardly ever leads to death or limb loss, its treatment should be as uninvasive as possible. Endovascular recanalization is an attractive option in this respect. A conclusive evaluation of the role of endovascular procedures in PTS must await randomized trials of this form of treatment and of the optimal stent configuration.
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67
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Huang C, Yu G, Huang J. Midterm Results of Endovascular Treatment for Iliac Vein Compression Syndrome from a Single Center. Ann Vasc Surg 2018; 49:57-63. [PMID: 29428534 DOI: 10.1016/j.avsg.2018.01.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 08/05/2017] [Accepted: 01/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The efficacy of endovascular interventional treatment for iliac vein compression syndrome (IVCS) is not well studied. The purpose of our study was to investigate the clinical outcome of endovascular interventional treatment for IVCS. METHODS Data of 68 patients with IVCS, who underwent interventional treatment in our hospital, were analyzed retrospectively. Among these patients, 46 had lower extremity varicose veins. Sixty-five patients underwent stent implantation, and 3 patients underwent simple balloon angioplasty. Fourteen patients had post-thrombotic syndrome (PTS) and 11 patients had acute deep venous thrombosis (DVT). Among these 14 patients with PTS, 12 underwent stent implantation and 2 underwent iliac venous simple balloon angioplasty. On the other hand, 9 of the 11 patients with DVT underwent catheter-directed thrombolysis (CDT) and then stent implantation. Of the remaining 2 patients, one underwent Angiojet Rheolytic thrombectomy (ART) before CDT and the other underwent CDT with simple balloon angioplasty. The stenosis rate of iliac vein and the circumference differences between the affected limb and healthy one were measured before and after operation. These patients were followed up with duplex ultrasound postoperatively. RESULTS A total of 75 stents were placed in 65 patients. The diameter and the length of stent were 6 to 14 mm (mean 12.5 ± 2.0 mm) and 40 to 260 mm (mean 82.5 ± 36.9 mm), respectively. CDT with/without ART was performed, using urokinase and/or alteplase, after inferior vena cava filtration in all of 11 patients with DVT, without the recurrence of pulmonary embolism. The difference in iliac venous stenosis was statistically significant ([91.2% ± 8.4%] [70.0% ∼ 100.0%] vs. 3.9% ± 13.0% [0 ∼ 70.0%], P < 0.01). The patency rates at 1-, 3-, 6- months, 1 year, and 2 years were 98.5%, 95.6%, 94.1%, 92.4%, and 90.7%, respectively. Four patients (5.9%) suffered from minor bleeding at puncture point and were successfully treated with compression. However, 1 (1.5%) patient underwent stent implantation of right iliac vein that became complicated due to migration of stent to the right ventricle which was successfully arrested by Amplatz Goose Neck Snare Kit. The incidence of PTS was 10.3% (7/68) during the follow-up at 1 to 24 (mean 18.2 ± 7.7) months. CONCLUSIONS Interventional therapy for patients of IVCS is safe and effective. Satisfactory outcomes were obtained for stent placement for IVCS.
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Affiliation(s)
- Chongqing Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Guanfeng Yu
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingyong Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Investigation of adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents in the iliac vein: insights into developing a better iliac vein stent. J Artif Organs 2018; 21:254-260. [PMID: 29411167 DOI: 10.1007/s10047-018-1023-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/28/2018] [Indexed: 01/14/2023]
Abstract
We analyzed the adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents for the treatment of iliac venous thromboembolism and investigated their relationships with the anatomical features of the iliac vein, to gain insights into the development of a better iliac vein stent. Reports of adverse events following the use of stents in the iliac vein were retrieved from the Manufacturer and User Facility Device Experience (MAUDE) database that contain suspected device-associated complications reported to the Food and Drug Administration. Data from 2006 to 2016 were investigated. The literature analysis was also conducted using PubMed, Cochrane Library, EMBASE, and Web of Science focusing on English articles published up to 4 October 2016. The analysis of 88 adverse events from the MAUDE database and 182 articles from the literature revealed that a higher number of adverse events had been reported following the use of arterial stents in the iliac vein compared to CE-marked iliac vein stents. While stent migration and shortening were reported only for the arterial stents, stent fracture and compression occurred regardless of the stent type, even though a vein does not pulsate. A study of the anatomical features of the iliac vein implies that bending, compression, and kink loads are applied to the iliac vein stents in vivo. For designing, developing, and pre-clinical testing of stents intended for use in the iliac vein, the above mechanical load environments induced by the anatomical features should be considered.
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Barbati ME, Gombert A, Toonder I, van Vuuren TMAJ, Schleimer K, Grommes J, Wittens CHA, Jalaie H. Detecting stent geometry changes after venous recanalization using duplex ultrasound. Phlebology 2018; 34:8-16. [DOI: 10.1177/0268355518757240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Patients with post-thrombotic syndrome due to chronic venous obstruction and resistant to conservative management can benefit from endovenous revascularization. The current study investigated the usefulness of duplex ultrasound in monitoring the stent changes over the time. Method All duplex ultrasound images of treated patients were reviewed retrospectively. The stent diameter and area during the follow-up visits have been analyzed. Result A total of 210 stents were placed in 137 limbs. Duplex ultrasound findings showed a decrease in area of stent in all patients (mean: 0.69 cm2). Reduction of stent area over the time was a predictor of stent patency (odds ratio: 0.910; confidence interval: 0.832–0.997). Conclusion Duplex ultrasound has sufficient accuracy in detection of stent changes and its patency. There is a discrepancy between diameter of the stent lumen in vitro and after deployment in all patients. Stent occlusion is related to reduction of stent lumen over the time rather than the percent of the stenosis.
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Affiliation(s)
- Mohammad E Barbati
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Alexander Gombert
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Irwin Toonder
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Timme MAJ van Vuuren
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Karina Schleimer
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Jochen Grommes
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Cees HA Wittens
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Houman Jalaie
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Abstract
Venous stenting for CVD is being increasingly used as more evidence accumulates supporting the open vein hypothesis and supporting the safety, efficacy, and durability of these interventions. As such, they can be offered to patients with advanced age and complex comorbidities. Future studies should focus on reporting outcomes specific to the underlying venous pathologic condition (thrombotic vs nonthrombotic and acute vs chronic) to provide better evidence for stenting in CVD, and the outcomes of new stent design with dedicated venous indications.
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71
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Ye K, Shi H, Yin M, Qin J, Yang X, Liu X, Jiang M, Lu X. Treatment of Femoral Vein Obstruction Concomitant with Iliofemoral Stenting in Patients with Severe Post-thrombotic Syndrome. Eur J Vasc Endovasc Surg 2017; 55:222-228. [PMID: 29292209 DOI: 10.1016/j.ejvs.2017.11.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 11/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim was to assess the clinical and anatomical outcomes of iliofemoral stenting, with concomitant femoral stenting or balloon angioplasty alone, in patients with severe post-thrombotic syndrome (PTS) and compromised inflow. METHODS A database of patients with severe PTS who successfully underwent endovascular iliofemoral stenting was reviewed retrospectively. Patients with impaired inflow with chronic post-thrombotic obstructive lesions in the femoral vein (FV), but patent profunda vein, were selected and divided into two groups: the FV stenting (FV-S) group and the FV angioplasty (FV-A) group. Patients in the FV-S group were treated with concomitant iliofemoral and FV stenting, and patients in the FV-A group were treated with iliofemoral stenting and balloon angioplasty alone of the obstructed femoral vein. The clinical and stent outcomes were recorded and compared in the two groups. RESULTS There were 45 patients in the FV-S group and 69 patients in the FV-A group. The groups were well matched for age, gender, and diseased limbs. The pre-procedural symptoms, CEAP classifications, VCSS scores, Villalta scores, and prevalence of active ulcers were also similar between the two groups. Immediate failure (<30 days post-procedure) in the femoral segment occurred more frequently in the FV-A group (70% in FV-A group vs. 24% in FV-S group, p < .001); however, all treated femoral vein segments had occluded at 12 months. There was no significant difference between the FV-S and FV-A groups in cumulative primary and secondary patency rates of the iliofemoral stent at 3 years (55% vs. 52%, p = .71, and 77% vs. 85%, p = .32, respectively). Complete pain relief, swelling relief, VCSS score, Villalta score, and freedom from ulcers at a median of 22 months (1-48 months) following the procedure were similar in the two groups. CONCLUSIONS Stent placement to treat post-thrombotic iliofemoral obstruction with concomitant obstructed femoral vein but patent profunda vein shows cumulative patency rates and clinical outcomes similar to previous reports. Adjunctive femoral stenting or angioplasty of the obstructed femoral vein does not appear to improve clinical or stent outcomes in patients with severe PTS.
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Affiliation(s)
- Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai, JiaoTong University, Shanghai, China
| | - Huihua Shi
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai, JiaoTong University, Shanghai, China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai, JiaoTong University, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai, JiaoTong University, Shanghai, China
| | - Xinrui Yang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai, JiaoTong University, Shanghai, China
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai, JiaoTong University, Shanghai, China
| | - Mier Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai, JiaoTong University, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai, JiaoTong University, Shanghai, China.
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Engelberger RP, Fahrni J, Willenberg T, Baumann F, Spirk D, Diehm N, Do DD, Baumgartner I, Kucher N. Fixed low-dose ultrasound-assisted catheter-directed thrombolysis followed by routine stenting of residual stenosis for acute ilio-femoral deep-vein thrombosis. Thromb Haemost 2017; 111:1153-60. [DOI: 10.1160/th13-11-0932] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/26/2013] [Indexed: 11/05/2022]
Abstract
SummaryPatients with ilio-femoral deep-vein thrombosis (DVT) are at high risk of developing the postthrombotic syndrome (PTS). In comparison to anticoagulation therapy alone, extended venography-guided catheter-directed thrombolysis without routine stenting of venous stenosis in patients with ilio-femoral DVT is associated with an increased risk of bleeding and a moderate reduction of PTS. We performed a prospective single-centre study to investigate safety, patency and incidence of PTS in patients with acute iliofemoral DVT treated with fixed-dose ultrasound-assisted catheter-directed thrombolysis (USAT; 20 mg rt-PA during 15 hours) followed by routing stenting of venous stenosis, defined as residual luminal narrowing >50%, absent antegrade flow, or presence of collateral flow at the site of suspected stenosis. A total of 87 patients (age 46 ± 21 years, 60% women) were included. At 15 hours, thrombolysis success ≥50% was achieved in 67 (77%) patients. Venous stenting (mean 1.9 ± 1.3 stents) was performed in 70 (80%) patients, with the common iliac vein as the most frequent stenting site (83%). One major (1%; 95% CI, 0–6%) and 6 minor bleedings (7%; 95%CI, 3–14%) occurred. Primary and secondary patency rates at 1 year were 87% (95% CI, 74–94%) and 96% (95% CI, 88–99%), respectively. At three months, 88% (95% CI, 78–94%) of patients were free from PTS according to the Villalta scale, with a similar rate at one year (94%, 95% CI, 81–99%). In conclusion, a fixed-dose USAT regimen followed by routine stenting of underlying venous stenosis in patients with iliofemoral DVT was associated with a low bleeding rate, high patency rates, and a low incidence of PTS.
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van Vuuren TM, Kurstjens RL, de Wolf MA, van Laanen JH, Wittens CH, de Graaf R. Stent extension into a single inflow vessel is a valuable option after endophlebectomy. Phlebology 2017; 33:610-617. [PMID: 29113541 PMCID: PMC6131728 DOI: 10.1177/0268355517739766] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Venous stenting with an endophlebectomy and arteriovenous fistula can be
performed in patients with extensive post-thrombotic changes. However, these
hybrid procedures can induce restenosis, sometimes requiring stent
extension, into a single inflow vessel. This study investigates the
effectiveness of stenting into a single inflow vessel. Methods All evaluated patients had temporary balloon occlusion of the arteriovenous
fistula to evaluate venous flow into the stents. When stent inflow was
deemed insufficient, AVF closure was postponed and additional stenting was
performed. Patency rates and clinical outcomes were evaluated. Results Twenty-four (38%) of 64 patients had additional stenting. The primary,
assisted primary and secondary patency were 60 %, 70% and 70% respectively.
Villalta score reduced by 6.1 points (p < 0.001), and
venous clinical severity score by 2.7 points
(p = 0.034). Conclusion Stenting through the femoral confluence into a single inflow vessel is a
feasible bailout option if primary hybrid intervention fails with relative
high patency rates and clinical improvement.
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Affiliation(s)
- Timme Maj van Vuuren
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Ralph Lm Kurstjens
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,3 Department of Obstetrics and Gynaecology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Mark Af de Wolf
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,4 Department of Radiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Jorinde Hh van Laanen
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cees Ha Wittens
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,5 Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Rick de Graaf
- 6 Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Raju S. Invited commentary. J Vasc Surg Venous Lymphat Disord 2017; 5:799. [PMID: 29037347 DOI: 10.1016/j.jvsv.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/04/2017] [Indexed: 11/17/2022]
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Editor's Choice - Reconstruction of the femoro-ilio-caval outflow by percutaneous and hybrid interventions in symptomatic deep venous obstruction. Eur J Vasc Endovasc Surg 2017; 54:495-503. [PMID: 28778457 DOI: 10.1016/j.ejvs.2017.06.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/23/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE/BACKGROUND Deep venous obstruction is relatively prevalent in patients with chronic venous disease. Endovascular treatments and hybrid interventions can be used to relieve venous outflow obstructions. This paper assesses mid-term clinical outcomes and patency rates in a large cohort after percutaneous and hybrid interventions. METHODS This was a prospectively analysed cohort study. Patients with symptomatic deep venous obstruction who presented at a tertiary referral hospital were divided into three groups: patients who underwent percutaneous stenting for non-thrombotic iliac vein compression syndrome (IVCS group); patients with post-thrombotic syndrome (PTS) treated by percutaneous stent placement (P-PTS group); and PTS patients with obstruction involving the veins below the saphenofemoral junction in which a hybrid procedure was performed, combining stenting with open surgical disobliteration (H-PTS group). Patency rates, complications, and clinical outcomes were analysed. RESULTS A total of 425 lower extremities in 369 patients were treated. At 60 months, primary patency, assisted primary patency, and secondary patency rates were 90%, 100%, and 100% for IVCS, and 64%, 81%, and 89% for the P-PTS group, respectively. The H-PTS group, showed patency rates of 37%, 62%, and 72%, respectively, at 36 months. Venous claudication subsided in 90%, 82%, and 83%, respectively. At the 24 month follow-up, mean Venous Clinical Severity Score decreased for all patients and improvement in Villalta score was seen in post-thrombotic patients. The number of complications was related to the extent of deep venous obstruction in which patients in the H-PTS group showed the highest complication rates (81%) and re-interventions (59%). CONCLUSION Percutaneous stent placement to treat non-thrombotic iliac vein lesions, and post-thrombotic ilio-femoral obstructions are safe, effective, and showed patency rates comparable with previous research. Patients with advanced disease needing a hybrid procedure showed a lower patency rate and more complications. However, when successful, the clinical outcome was favourable at mid-term follow-up and the procedure may be offered to selected patients.
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Pokrovsky A, Ignatyev I, Gradusov E. First Experience of Performing Hybrid Operations in Chronic Venous Obstructions of Iliofemoral Segments in Patients With Postthrombotic Syndrome. Vasc Endovascular Surg 2017; 51:447-452. [PMID: 28731380 DOI: 10.1177/1538574417717609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE 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.
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Affiliation(s)
- Anatoly Pokrovsky
- 1 Department of Vascular Surgery, Vishnevsky Institute of Surgery, Moscow, Russia.,2 Department of Vascular Surgery, Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - Igor Ignatyev
- 3 Department of Vascular Surgery, Interregional Clinical and Diagnostic Center, Kazan, Russia.,4 Department of Vascular Surgery, Kazan State Medical University, Kazan, Russia
| | - Evgeny Gradusov
- 2 Department of Vascular Surgery, Russian Medical Academy of Postgraduate Education, Moscow, Russia
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Gombert A, Barbati ME, Grommes J, Kurstjens RL, deWolf MA, Wittens CH, Jalaie H. Wound complications after common femoral vein endophlebectomy: Influence on outcome. Phlebology 2017; 33:407-417. [PMID: 28595505 DOI: 10.1177/0268355517714712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Venous recanalization of obstructed femoral and iliac veins is associated with good results regarding the feasibility and patency rate. If the common femoral vein with its inflow vessels is involved, open surgical desobliteration or endophlebectomy has been described as a crucial part of the intervention. However, when performing the hybrid procedure, a number of specific complications have been described. We present our results after venous recanalization including an endophlebectomy, focussing on wound complications and its impact on outcome. Material and methods A retrospective analysis of prospective recorded data of all patients who underwent a hybrid procedure for chronic obstruction of iliofemoral veins between 2010 and 2015 was performed. The patients were treated by recanalization of the affected veins combined with endophlebectomy of the common femoral vein and arteriovenous fistula implantation. Data assessment focussed on complications and patency rates. Results This study includes 96 patients, thereof 58 females with a mean age of 44.1 years. The mean procedure time was 344 ± 140 min (range 124-663). Median follow-up time was 12.5 months (2-33 months). Primary patency was 62.5% and secondary patency was 90%. Re-intervention due to early occlusion within the first 30 post-intervention days was necessary in 37.5% of all cases. Besides bleeding complications, wound complications, mainly classified as Szilagyi I, occurred in 33% of all patients. A multivariate analysis showed a significant impact of wound complications on primary as well as secondary patency rate ( p = 0.032, respectively 0.015). Conclusion Recanalization of obstructed iliac veins and/or the inferior vena cava combined with endophlebectomy of the common femoral vein and arteriovenous fistula implantation is a safe and feasible treatment option in the post-thrombotic syndrome. As wound complications are a common and associated with a significant impact on patency rate, further attempts to improve the procedure are crucial.
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Affiliation(s)
- Alexander Gombert
- 1 European Venous Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany
| | - Mohammad E Barbati
- 1 European Venous Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany
| | - Jochen Grommes
- 1 European Venous Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany
| | - Ralph Lm Kurstjens
- 2 Department of Obstetrics and Gynaecology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Mark Af deWolf
- 3 European Venous Center Aachen-Maastricht, Maastricht University Hospital, Maastricht, the Netherlands.,4 Department of Radiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Cees Ha Wittens
- 1 European Venous Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany.,3 European Venous Center Aachen-Maastricht, Maastricht University Hospital, Maastricht, the Netherlands
| | - Houman Jalaie
- 1 European Venous Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany
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Ruihua W, Xin W, Guang L, Kaichuang Y, Jinbao Q, Minyi Y, Weimin L, Xiaobing L, Xintian H, Min L, Xinwu L. Technique and Clinical Outcomes of Combined Stent Placement for Postthrombotic Chronic Total Occlusions of the Iliofemoral Veins. J Vasc Interv Radiol 2017; 28:373-379. [DOI: 10.1016/j.jvir.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
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Abstract
OBJECTIVE The purpose of this article is to describe the indications for and approach to catheter-based treatment of acute venous thromboembolism (VTE). CONCLUSION Catheter-based treatment of VTE is a viable adjunct to anticoagulant therapy and is being rapidly adopted around the United States. Early data suggest that these therapies reduce postthrombotic sequelae and improve quality of life, but bleeding events are still frequent, particularly at low-volume centers. Protocols need to be standardized to improve patient care.
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de Wolf MAF, Jalaie H, van Laanen JHH, Kurstjens RLM, Mensinck MJS, de Geus MJ, Gombert A, de Graaf R, Wittens CHA. Endophlebectomy of the common femoral vein and arteriovenous fistula creation as adjuncts to venous stenting for post-thrombotic syndrome. Br J Surg 2017; 104:718-725. [DOI: 10.1002/bjs.10461] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/05/2016] [Accepted: 11/18/2016] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Good results have been reported for angioplasty and stenting of post-thrombotic lesions of the iliac and proximal femoral veins. If lesions at the origin of the superficial femoral and profunda veins are stented, the intraluminal synechiae can be pushed against the orifices of inflow vessels, potentially decreasing stent inflow. Surgical disobliteration of the common femoral vein (endophlebectomy) has been suggested to mitigate this problem. Because of a temporary increase in thrombogenicity, this procedure may be accompanied by arteriovenous fistula creation.
Methods
Data on consecutive patients treated by hybrid venous reconstruction, between December 2010 and May 2015, were analysed. Standard recording consisted of clinical scoring systems (including Villalta scale) and imaging. Patency was assessed with duplex ultrasonography.
Results
Seventy-six legs (70 patients) were included. Median follow-up was 379 (range 73–1508) days. Primary, assisted primary and secondary patency rates at 12 months were 51, 70 and 83 per cent respectively. Sixty per cent of loss of primary patency (24 of 40 legs) was related to common femoral vein stenosis, and the rest to rethrombosis. Other complications included wound infection (29 per cent) and lymphatic leak (39 per cent). The Villalta score had decreased by a median of 7 points at 1-year follow-up.
Conclusion
The combination of venous stenting, endophlebectomy and arteriovenous fistula creation for patients with extensive post-thrombotic vein damage and severe post-thrombotic syndrome is feasible.
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Affiliation(s)
- M A F de Wolf
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - H Jalaie
- Department of Vascular Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Nordrhein-Westfalen, Aachen, Germany
| | - J H H van Laanen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R L M Kurstjens
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - M J S Mensinck
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M J de Geus
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A Gombert
- Department of Vascular Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Nordrhein-Westfalen, Aachen, Germany
| | - R de Graaf
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C H A Wittens
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Vascular Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Nordrhein-Westfalen, Aachen, Germany
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81
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Verma H, Tripathi RK. Common femoral endovenectomy in conjunction with iliac vein stenting to improve venous inflow in severe post-thrombotic obstruction. J Vasc Surg Venous Lymphat Disord 2017; 5:138-142. [DOI: 10.1016/j.jvsv.2016.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/25/2016] [Indexed: 10/20/2022]
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82
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Murphy EH, Johns B, Varney E, Raju S. Endovascular management of chronic total occlusions of the inferior vena cava and iliac veins. J Vasc Surg Venous Lymphat Disord 2017; 5:47-59. [DOI: 10.1016/j.jvsv.2016.07.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/13/2016] [Indexed: 11/26/2022]
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83
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Iliofemoral stenting for chronic venous occlusive disease: Initial and mid-term outcomes in single institution. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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84
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Jayaraj A, Raju S. Review of Complex Iliocaval Reconstructions. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jalaie H, Schleimer K, Barbati ME, Gombert A, Grommes J, de Wolf MAF, de Graaf R, Wittens CHA. Interventional treatment of postthrombotic syndrome. GEFASSCHIRURGIE : ZEITSCHRIFT FUR VASKULARE UND ENDOVASKULARE CHIRURGIE : ORGAN DER DEUTSCHEN UND DER OSTERREICHISCHEN GESELLSCHAFT FUR GEFASSCHIRURGIE UNTER MITARBEIT DER SCHWEIZERISCHEN GESELLSCHAFT FUR GEFASSCHIRURGIE 2016; 21:37-44. [PMID: 27546987 PMCID: PMC4974289 DOI: 10.1007/s00772-016-0156-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postthrombotic syndrome (PTS) is the development of symptoms and signs of chronic venous insufficiency following deep vein thrombosis (DVT) and has a significant negative effect on the quality of life. The current understanding is that the clinical manifestation of PTS is related more to venous obstruction than it is to venous reflux. The use of interventional techniques for the treatment of venous obstruction and/or venous occlusion has rapidly increased in recent years. OBJECTIVE This article summarizes the current concept of endovenous and hybrid interventions and presents the optimized treatment of choice in patients with chronic symptomatic venous obstruction. METHODS We performed a systematic literature search in the Medline database to identify relevant studies on the treatment of patients with PTS. RESULTS A meta-analysis of the relevant studies showed that this minimally invasive procedure is an effective treatment option with low morbidity and no mortality. Use of the newly developed dedicated venous stents showed promising results with good mid-term patency rates and a significant decrease in related symptoms. CONCLUSION Interventional therapy for the treatment of symptomatic chronic venous obstruction has become the method of choice in recent years. More studies are needed to evaluate the long-term success rate of dedicated venous stents.
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Affiliation(s)
- H. Jalaie
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - K. Schleimer
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - M. E. Barbati
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - A. Gombert
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - J. Grommes
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - M. A. F. de Wolf
- European Vascular Center Aachen-Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R. de Graaf
- European Vascular Center Aachen-Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C. H. A. Wittens
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
- European Vascular Center Aachen-Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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Shi WY, Gu JP, Liu CJ, He X, Lou WS. Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis: A retrospective study on mid-term in-stent patency from a single center. Eur J Radiol 2016; 85:7-14. [DOI: 10.1016/j.ejrad.2015.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
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Seager MJ, Busuttil A, Dharmarajah B, Davies AH. Editor's Choice-- A Systematic Review of Endovenous Stenting in Chronic Venous Disease Secondary to Iliac Vein Obstruction. Eur J Vasc Endovasc Surg 2015; 51:100-20. [PMID: 26464055 DOI: 10.1016/j.ejvs.2015.09.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/02/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Deep endovenous stenting to relieve chronic venous disease (CVD) secondary to post-thrombotic or non-thrombotic iliac vein obstruction is becoming increasingly well described. However, current and adequately reported systematic reviews on the topic are lacking. This report aimed to produce a systematic review and meta-analysis of the available data, reported to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline. METHODS MEDLINE, EMBASE, and the Cochrane Central Register for Controlled Trials databases and key references were searched. RESULTS Sixteen studies were included (14 before-and-after studies, 1 controlled before-and-after study, and 1 case series) encompassing successful deep venous stenting in 2,373 and 2,586 post-thrombotic or non-thrombotic limbs and patients respectively. The data were too heterogeneous to perform a meta-analysis. There were significant improvements in validated measures of the severity of CVD and venous disease-specific quality of life. Persistent ulcer healing rates ranged from 56% to 100% in limbs that had often already failed conservative management. Primary and secondary stent patency ranged from 32% to 98.7% and 66%-96% respectively. The major complication rate ranged from 0 to 8.7% per stented limb. A GRADE assessment demonstrated the quality of the evidence for five outcomes to be "Very Low" and one to be "Low" (ulcer healing). CONCLUSIONS The quality of evidence to support the use of deep venous stenting to treat obstructive CVD is currently weak. The treatment does however appear promising and is safe and should therefore be considered as a treatment option while the evidence base is improved.
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Affiliation(s)
- M J Seager
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - A Busuttil
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - B Dharmarajah
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - A H Davies
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK.
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Klitfod L, Just S, Foegh P, Baekgaard N. Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome. Acta Radiol Open 2015; 4:2058460115592164. [PMID: 26445677 PMCID: PMC4580121 DOI: 10.1177/2058460115592164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022] Open
Abstract
Background Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired quality of life in more than 50%. Endovascular treatment for iliac vein obstruction using stents is known to alleviate PTS symptoms in selected patients. Purpose To report the Danish long-term results of endovascular treatment with iliac stenting. Material and Methods From 2000 to 2013 consecutive patients were evaluated and 19 patients with severe venous claudication were identified and subsequently underwent angioplasty and stenting. AC treatment was prescribed for 6 months, and knee-high class II compression stocking recommended for 1 year. Scheduled follow-up was done in the outpatient clinic at 6 weeks, 3 months, and annually thereafter. Results Nineteen patients, all women, all with left-sided iliac vein obstruction, and all with severe PTS symptoms were included. The median follow-up time was 81 months (range, 1–146 months; mean, 69 months). Primary patency rate of the inserted iliac stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. Conclusion Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS.
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Affiliation(s)
- Lotte Klitfod
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Sven Just
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Pia Foegh
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Niels Baekgaard
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
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Wen-da W, Yu Z, Yue-Xin C. Stenting for chronic obstructive venous disease: A current comprehensive meta-analysis and systematic review. Phlebology 2015. [PMID: 26205370 DOI: 10.1177/0268355515596474] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this article was to summarize the efficacy and safety of venous stents in chronic obstructive venous disease (COVD) including postthrombotic syndrome (PTS) and nonthrombotic iliac vein lesions (NIVL). METHODS We searched PubMed for case series (prospective and retrospective) that focused on venous stents in the treatment of COVD published between 1st January, 2000 and 15th July, 2014. Then, we analyzed the perioperative complications, subsequent antithrombotic treatment, clinical outcomes, and long-term patency of this procedure. RESULTS Overall, 1987 patients from 14 studies were included in our study. The incidence of the 30-day thrombotic events was 2.0% (4.0% in PTS vs. 0.8% in NIVL, p = 0.0002). The rates of access site complications and stent migration were 1.7% and 1.3%, respectively. The incidence of retroperitoneal bleeding and contrast extravasation was 1.8%. Back pain was more common with a rate of 62.9%. With stent placement, there was a significant pain and edema relief in COVD patients and the clinical-etiology-anatomy-pathophysiology scores declined. The rate of ulcer healing was 72.1% (70.3% in PTS vs. 86.9% in NIVL, p = 0.0022), and the ulcer recurrence rate was 8.7%. The primary, assisted primary, and secondary patency rates were 91.4%, 95.0%, and 97.8%, respectively, at 12 months and 77.1%, 92.3%, and 94.3%, respectively, at 36 months; however, the patency rates in PTS were lower than those in NIVL. CONCLUSIONS Stents may be a relatively effective and safe approach for PTS and NIVL patients because of the low incidence of perioperative complications and satisfying long-term patency. Some outcomes of stents in NIVL patients may be better than those in PTS patients.
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Affiliation(s)
- Wang Wen-da
- The Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhao Yu
- The Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chen Yue-Xin
- The Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Abstract
Management of venous ulceration has evolved tremendously during the last 2 decades. There has been considerable progress in our understanding of the pathophysiology, hemodynamics, venous imaging, and therapeutic options for venous ulcers, including endovenous ablation, iliac vein stenting, and vein-valve repair techniques. Details of these procedures are described in this issue of Seminars. With so many permutations and combinations of venous disease, including superficial and deep vein abnormalities, that produce venous ulceration, as well as a plethora of diagnostic and therapeutic tools at our disposal, it is important to have an algorithm for venous ulcer management. Also important is knowledge about risk factors that can influence poor outcomes, despite interventions for venous ulcers. In the end, authors also discuss the gray areas of venous ulcer management, which do not have common consensus and that treatment could be individualized based on patient needs.
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Affiliation(s)
- Himanshu Verma
- Narayana Institute of Vascular Sciences, Level I, B Block, NH-Mazumdar Shaw Medical Centre, Narayana Healthcare, 258-A, Bommasandra Industrial Area, Hosur Road, Bangalore 560099, India
| | - Ramesh K Tripathi
- Narayana Institute of Vascular Sciences, Level I, B Block, NH-Mazumdar Shaw Medical Centre, Narayana Healthcare, 258-A, Bommasandra Industrial Area, Hosur Road, Bangalore 560099, India.
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Cho H, Kim JW, Hong YS, Lim SH, Won JH. Stent Compression in Iliac Vein Compression Syndrome Associated with Acute Ilio-Femoral Deep Vein Thrombosis. Korean J Radiol 2015; 16:723-8. [PMID: 26175570 PMCID: PMC4499535 DOI: 10.3348/kjr.2015.16.4.723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/23/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study was conducted to evaluate stent compression in iliac vein compression syndrome (IVCS) and to identify its association with stent patency. MATERIALS AND METHODS Between May 2005 and June 2014, after stent placement for the treatment of IVCS with acute ilio-femoral deep vein thrombosis, follow-up CT venography was performed in 48 patients (35 women, 13 men; age range 23-87 years; median age 56 years). Using follow-up CT venography, the degree of the stent compression was calculated and used to divide patients into two groups. Possible factors associated with stent compression and patency were evaluated. The cumulative degree of stent compression and patency rate were analyzed. RESULTS All of the stents used were laser-cut nitinol stents. The proportion of limbs showing significant stent compression was 33%. Fifty-six percent of limbs in the significant stent compression group developed stent occlusion. On the other hand, only 9% of limbs in the insignificant stent compression group developed stent occlusion. Significant stent compression was inversely correlated with stent patency (p < 0.001). The median patency period evaluated with Kaplan-Meier analysis was 20.0 months for patients with significant stent compression. Other factors including gender, age, and type of stent were not correlated with stent patency. Significant stent compression occurred most frequently (87.5%) at the upper end of the stent (ilio-caval junction). CONCLUSION Significant compression of nitinol stents placed in IVCS highly affects stent patency. Therefore, in order to prevent stent compression in IVCS, nitinol stents with higher radial resistive force may be required.
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Affiliation(s)
- Hun Cho
- Department of Radiology, Ajou University School of Medicine, Suwon 443-380, Korea
| | - Jin Woo Kim
- Department of Radiology, Ajou University School of Medicine, Suwon 443-380, Korea
| | - You Sun Hong
- Department of Thoracic & Cardiovascular Surgery, Ajou University School of Medicine, Suwon 443-380, Korea
| | - Sang Hyun Lim
- Department of Thoracic & Cardiovascular Surgery, Ajou University School of Medicine, Suwon 443-380, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon 443-380, Korea
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de Graaf R, de Wolf M, Sailer AM, van Laanen J, Wittens C, Jalaie H. Iliocaval Confluence Stenting for Chronic Venous Obstructions. Cardiovasc Intervent Radiol 2015; 38:1198-204. [PMID: 25772400 PMCID: PMC4565871 DOI: 10.1007/s00270-015-1068-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/29/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Different techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions. MATERIALS AND METHODS Between 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents. RESULTS Recanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7-1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency. In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29-337) days. CONCLUSION Stenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.
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Affiliation(s)
- Rick de Graaf
- Department of Radiology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Mark de Wolf
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
| | - Anna M Sailer
- Department of Radiology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Jorinde van Laanen
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
| | - Cees Wittens
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands. .,Department of Surgery, University Hospital Aachen, Aachen, Germany.
| | - Houman Jalaie
- Department of Surgery, University Hospital Aachen, Aachen, Germany.
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Kurstjens RLM, de Graaf R, Barbati ME, de Wolf MAF, van Laanen JHH, Wittens CHA, Jalaie H. Arteriovenous fistula geometry in hybrid recanalisation of post-thrombotic venous obstruction. Phlebology 2015; 30:42-9. [DOI: 10.1177/0268355514568270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Post-thrombotic obstruction can be adequately treated by percutaneous transluminal angioplasty and stenting. When post-thrombotic trabeculations extend below the femoral confluence, proper inflow can be facilitated by endophlebectomy and creation of an arteriovenous fistula. The aim of this study was to investigate whether it is more favourable to place the arteriovenous fistula at the cranial or caudal end of the endophlebectomy to prevent stenosis or occlusion. Methodology We retrospectively analysed the clinical data of all patients who underwent a hybrid procedure in our two centres. Demographics, interventional details and post-operative imaging were collected. Results Data on 42 limbs with cranially and 23 limbs with caudally placed arteriovenous fistulas were collected. Post-thrombotic disease of the profunda femoral vein alone or in combination with the femoral vein was observed more often in the cranial group. The caudal group more often received a smaller sized and straight polytetrafluoroethylene fistula, while the cranial group comprised a significantly higher amount of stented segments. Logistic regression showed that only reduced femoral inflow (hazard ratio 2.934 (95%CI, 1.148–7.494)) was a significant predictor of stent stenosis and/or occlusion. Logistic regression for risk of occlusion showed a significant influence of stent-related complications (hazard ratio 4.691 (95%CI, 1.205–18.260)) and a tendency towards influence of arteriovenous fistula geometry in favour of the cranially placed fistula. Conclusion Placement of the arteriovenous fistula in the cranial part of the endophlebectomy during hybrid recanalisation may result in a more favourable outcome, yet this tendency was not statistically significant. Moreover, femoral inflow is pivotal in maintaining patency and should thus be adequately assessed pre-operatively.
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Affiliation(s)
- RLM Kurstjens
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - R de Graaf
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - ME Barbati
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - MAF de Wolf
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - JHH van Laanen
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - CHA Wittens
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - H Jalaie
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
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95
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Birn J, Vedantham S. May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med 2014; 20:74-83. [PMID: 25502563 DOI: 10.1177/1358863x14560429] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Acute and chronic venous disorders of the lower extremities affect millions of people and cause substantial disability. Long ago, surgeons and pathologists identified the presence of 'spur-like' abnormalities of the left common iliac vein; these abnormalities were hypothesized to result from compression and/or irritation from the adjacent crossing right common iliac artery. In the 1990s, physicians, starting to perform catheter-directed thrombolysis to treat extensive deep vein thrombosis (DVT), observed that about 50% of patients had an iliac vein stenosis. Vascular physicians have become aware of the occasional patient with otherwise-unexplained extremity swelling and/or pain but without a DVT history who is subsequently found to have an iliac vein abnormality. These 'lesions' have been hypothesized to elevate ambulatory venous pressures and thereby produce lower-extremity symptoms, increase the risk of initial and recurrent DVT episodes, and increase the risk of treatment failure with medical and endovascular therapies for thrombotic and non-thrombotic venous conditions. As a result, many practitioners now actively seek iliac venous obstructive 'lesions' when evaluating patients with known or suspected venous disease. However, for many patients, it continues to be unclear what degree of obstruction to venous blood flow is being caused by such lesions, how clinically significant they are, how much emphasis should be placed on identifying them, and when they should be treated. This article seeks to improve the knowledge base of vascular practitioners who make clinical decisions about the diagnosis and treatment of obstructive iliac vein lesions.
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Affiliation(s)
- Jeffrey Birn
- Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Suresh Vedantham
- Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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96
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Tratamiento recanalizador de las trombosis venosas del sector iliofemoral. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2014.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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97
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Raju S, Ward M, Kirk O. A Modification of Iliac Vein Stent Technique. Ann Vasc Surg 2014; 28:1485-92. [DOI: 10.1016/j.avsg.2014.02.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/06/2014] [Accepted: 02/26/2014] [Indexed: 12/01/2022]
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98
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Sang H, Li X, Qian A, Meng Q. Outcome of Endovascular Treatment in Postthrombotic Syndrome. Ann Vasc Surg 2014; 28:1493-500. [DOI: 10.1016/j.avsg.2014.03.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
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99
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Crowner J, Marston W, Almeida J, McLafferty R, Passman M. Classification of anatomic involvement of the iliocaval venous outflow tract and its relationship to outcomes after iliocaval venous stenting. J Vasc Surg Venous Lymphat Disord 2014; 2:241-5. [DOI: 10.1016/j.jvsv.2014.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/05/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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100
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Caliste XA, Clark AL, Doyle AJ, Cullen JP, Gillespie DL. The incidence of contralateral iliac venous thrombosis after stenting across the iliocaval confluence in patients with acute or chronic venous outflow obstruction. J Vasc Surg Venous Lymphat Disord 2014; 2:253-9. [DOI: 10.1016/j.jvsv.2013.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/03/2013] [Accepted: 12/22/2013] [Indexed: 12/01/2022]
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