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Tu LK, Nie ML, Fu J, Liu FY, Chen YK, Sun JM, Wang HY. Comparing the efficacy of endovascular treatment for iliac vein compression syndrome with or without acute deep venous thrombosis: A single-center retrospective study. Vascular 2021; 30:341-348. [PMID: 33853455 DOI: 10.1177/17085381211003776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To compare the efficacy of endovascular treatment for iliac vein compression syndrome (IVCS) with or without acute deep venous thrombosis of lower extremity. METHODS This study retrospectively analyzed the clinical data of 300 IVCS patients, who received endovascular treatment between January 2013 and December 2017. According to whether IVCS was complicated by deep venous thrombosis or not, these patients were divided into non-thrombotic iliac vein lesion group (NIVL group, n = 127) and post-thrombotic iliac vein lesion group (PIVL group, n = 173). After endovascular treatment, all patients were followed up to assess the symptoms improvement and to evaluate the patency of iliac vein. RESULTS The technical success rate was 98% (294/300), and percutaneous transluminal angioplasty with stenting was adopted in 294 cases. The incidence of perioperative complications was 36.33% (109/300), but no severe complications occurred. During a mean follow-up of 22.3 months (range 6-30 months), 9(6.82%, 9/132) patients in PIVL group had recurrence of deep venous thrombosis, but nobody had deep venous thrombosis and varicose veins recurrence in NIVL group. The effective rate of endovascular treatment in NIVL group and PIVL group was 96.88% and 90.15% (P = 0.050), while the cumulative primary patency of iliac vein in NIVL group was significantly higher than that in PIVL group (P = 0.008). CONCLUSIONS The endovascular treatment is an effective, feasible, safe method for treating IVCS. There is no difference in the efficacy of IVCS patients with or without deep venous thrombosis, but the medium and long-term patency of patients with deep venous thrombosis is lower than that in patients without deep venous thrombosis.
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Affiliation(s)
- L K Tu
- Department of Gastroenterology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - M L Nie
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - J Fu
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - F Y Liu
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Y K Chen
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - J M Sun
- Department of Gastroenterology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - H Y Wang
- Department of Gastroenterology, University-Town Hospital of Chongqing Medical University, Chongqing, China
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Endovascular Treatment of Post-thrombotic Venous Ilio-Femoral Occlusions: Prognostic Value of Venous Lesions Caudal to the Common Femoral Vein. Cardiovasc Intervent Radiol 2019; 42:1117-1127. [PMID: 31062068 DOI: 10.1007/s00270-019-02214-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To propose a scale of severity for post-thrombotic venous lesions (PTVLs) after ilio-femoral deep venous thrombosis and to compare the grade with the results of endovascular treatment of ilio-femoral PTVLs. METHODS In this retrospective monocentric observational study, we included 95 patients treated for ilio-femoral PTVLs. We proposed a four-grade scale evaluating the severity of PTVLS caudal to the common femoral vein based on CT phlebography and per-operative phlebography. For most patients, venous patency was assessed with color duplex ultrasonography and the clinical efficacy of the intervention using the Villalta and CIVIQ scores. RESULTS Recanalization was successful in 100% of patients with a morbidity rate of 4%. After a mean follow-up of 21 months, the overall primary patency was 75%, the assisted primary patency 82%, and the secondary patency 93%. Secondary patency was 100% for grade 0-1, 90% for grade 2, and 63% for grade 3 (p < 0.002). There was no correlation between the extension of stenting caudally of the common femoral vein and venous patency. The mean improvements in the Villalta and CIVIQ-20 scores were, respectively, 4.6 (p < 0.0001) and 18 (p < 0.0001); scores were not correlated with the grade of PTVLs in the thigh. CONCLUSION Venous patency after endovascular treatment of ilio-femoral PTVLs was strongly linked to the severity of PTVLs caudal to the common femoral vein but not to the extent of stenting.
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Venous duplex ultrasound protocol for iliocaval disease. J Vasc Surg Venous Lymphat Disord 2018; 6:748-757. [DOI: 10.1016/j.jvsv.2018.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
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Kong J, Liu P, Li J, Fan X, Wen J, Zhang J, Xu R, Cui Y, Zhen X, Ye Z. Surgical treatment of recurrent varicose veins in the lower limbs associated with endovascular treatment of iliac vein stenosis. Int J Surg 2018; 50:110-113. [PMID: 29337179 DOI: 10.1016/j.ijsu.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/01/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We present our experience with endovascular surgery for recurrent varicose veins (RVV) of the lower limbs combined with the iliac vein compression syndrome (IVCS). MATERIALS AND METHODS This study was a retrospective analysis of 6 patients with RVVs combined with IVCS who were admitted to our hospital between January 2007 and December 2014. Transfemoral venography was performed to confirm IVCS. Balloon dilation and stent placement were successful in all 6 patients. The varicose veins were treated by traditional surgery after the endovascular therapy. The visual analog pain scale (VAS) score and venous clinical severity score (VCSS) were collected before surgery and at 6-months follow-up, and were analyzed using the paired student t-test. Patency of the iliac vein was assessed via duplex Doppler ultrasound. RESULTS The rate of technical success was 100%. There was a significant (p < .001) improvement in VCSS postoperatively. During the 6-month follow-up period, no RVVs were observed and the rate of iliac vein patency was 100%. Importantly, VAS ratings also decreased significantly (p < .001) during the follow-up. CONCLUSION Endovascular surgery for IVCS combined with traditional surgery focused on varicose veins is an effective procedure for treating RVVs of the lower limbs associated with IVCS within 6 months.
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Affiliation(s)
- Jie Kong
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Jinyong Li
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Xueqiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Jianyan Wen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Jianbin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Rongwei Xu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Yiyao Cui
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Xia Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China, Graduate School of Peking Union Medical College, Beijing, 100029, China.
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Saha P, Black S, Breen K, Patel A, Modarai B, Smith A. Contemporary management of acute and chronic deep venous thrombosis. Br Med Bull 2016; 117:107-20. [PMID: 26893407 DOI: 10.1093/bmb/ldw006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This review aims to provide an update on the management of deep vein thrombosis (DVT). SOURCES OF DATA A systematic search of PubMed, Google Scholar and Cochrane databases was carried out. AREAS OF AGREEMENT Direct oral anticoagulants (DOACs) are as effective and easier to use than vitamin K antagonists for the treatment of DVT. Catheter-directed thrombolysis can reduce post thrombotic syndrome in patients with iliofemoral DVT. Compression bandaging can help heal a venous ulcer. AREAS OF CONTROVERSY Compression hosiery to prevent post thrombotic syndrome. Long-term evidence to show clinical benefit of using endovenous therapies to restore deep vein patency. GROWING POINTS Developing imaging methods to identify patients who would benefit from venous thrombolysis. The evolution of dedicated venous stents. AREAS TIMELY FOR DEVELOPING RESEARCH Understanding the mechanisms that lead to stent occlusion and investigation into the appropriate treatments that could prevent in-stent thrombosis is required.
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Affiliation(s)
- Prakash Saha
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Stephen Black
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Karen Breen
- Department of Thrombosis and Haemostasis, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, London SE1 7EH, UK
| | - Ashish Patel
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Bijan Modarai
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Alberto Smith
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
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Åkesson M, Lehti L, Höglund P, Åkeson P, Wassélius J. Gadofosveset-enhanced magnetic resonance venography in patients with venous pathology of the lower limbs - Comparison of diagnostic image quality and inter-rater variability with gadobutrol venography and computed tomography venography. Phlebology 2015; 31:737-743. [PMID: 26631538 DOI: 10.1177/0268355515619255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose This study was performed to compare the diagnostic quality of Gadofosveset-enhanced magnetic resonance venography with Gadobutrol-enhanced magnetic resonance venography and computed tomography venography for the deep veins of the lower extremities in patients with iliocaval venous pathology. Materials and methods Diagnostic capability and image quality were assessed by two independent readers. Inter-reader variability was analyzed by unweighted and quadratic weighted Cohen's kappa values. Results The diagnostic capability was equal to or higher in the Gadofosveset group for all examined vessel segments compared with both control groups. The image quality score was significantly higher for the Gadofosveset group compared to both control groups. Inter-reader variability expressed by quadratic weighted Cohen's kappa value (k) showed less variability in the Gadofosveset group compared to the control groups. Conclusion Our results show that Gadofosveset-enhanced magnetic resonance venography is a reliable technique in clinical routine practice, with image quality superior to both Gadobutrol-enhanced magnetic resonance venography and computed tomography venography.
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Affiliation(s)
- Michael Åkesson
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Leena Lehti
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,2 Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Peter Höglund
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Per Åkeson
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,3 Department of Radiology, Trelleborg Hospital, Trelleborg, Sweden
| | - Johan Wassélius
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,4 Department of Neuroradiology, Skåne University Hospital, Lund, Sweden
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Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 505] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mahnken AH, Thomson K, de Haan M, O'Sullivan GJ. CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Intervent Radiol 2014; 37:889-97. [PMID: 24633533 DOI: 10.1007/s00270-014-0875-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/02/2013] [Indexed: 02/07/2023]
Abstract
Chronic venous insufficiency (CVI) as an advanced stage of chronic venous disease is a common problem that occurs in approximately 1-5 % of the adult population. CVI has either a nonthrombotic (primary) or postthrombotic (secondary) cause involving reflux, obstruction, or a combination of both. The role of venous obstruction is increasingly recognized as a major cause of CVI, with obstructive lesions in the iliocaval segment being markedly more relevant than lesions at the levels of the crural and femoral veins. Approximately 70-80 % of iliac veins develop a variable degree of obstruction following an episode of acute deep venous thrombosis. Nonthrombotic iliac vein obstruction also known as May-Thurner or Cockett's syndrome is the most common cause of nonthrombotic iliac vein occlusion. While compression therapy is the basis of therapy in CVI, in many cases, venous recanalization or correction of obstructive iliac vein lesions may result in resolution of symptoms. This document reviews the current evidence on iliocaval vein recanalization and provides standards of practice for iliocaval stenting in primary and secondary causes of chronic venous disease.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital, Philipps-Marburg, Baldingerstraße, D-35043, Marburg, Germany,
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Mousa AY, AbuRahma AF. May–Thurner Syndrome: Update and Review. Ann Vasc Surg 2013; 27:984-95. [DOI: 10.1016/j.avsg.2013.05.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 01/27/2023]
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