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Hu J, Feng H, Zheng Y, Wang K, Wang X, Su J. Mechanism of effect of stenting on hemodynamics at iliac vein bifurcation. Comput Biol Med 2024; 170:107968. [PMID: 38244472 DOI: 10.1016/j.compbiomed.2024.107968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
When performing stent intervention for iliac vein compression syndrome, the operator selects the appropriate stent and determines its implantation depth according to the type and severity of iliac vein stenosis in the patient. However, there is still uncertainty regarding how the structure of the stent and its implantation depth affect hemodynamics at the site of lesion. In this paper, we analyzed three commonly used stents (Vena stent from Venmedtch, Venovo from Bard, and Smart stent from Cordis) with different implantation depths (0, 10, 20 mm) using computational fluid dynamics (CFD). We focused on evaluating hemorheological parameters such as time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), etc., within one pulsatile cycle after stent implantation. The correlation between geometric parameters of the stents and hemodynamic indicators was assessed using Pearson correlation coefficient (r), which was further validated through PIV velocity measurement experiment. The results revealed that an increase in implantation depth led to a more pronounced disturbance effect on blood flow at bifurcation for densely arranged support body-type stents. This effect was particularly significant during periods of smooth blood flow. On the other hand, crown-shaped Vena stents exhibited relatively less disruption to blood flow post-implantation. Implantation depth showed a strong negative correlation with TAWSS but a strong positive correlation with OSI and RRT. These findings suggest an increased risk of thrombosis at iliac vein bifurcation following stent placement. Amongst all three tested stents, Vena Stent demonstrated more favorable periodic parameters after implantation compared to others. These results provide valuable theoretical insights into understanding contralateral circulation thrombosis associated with iliac vein stenting.
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Affiliation(s)
- Jinming Hu
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, 010000, PR China
| | - Haiquan Feng
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, 010000, PR China.
| | - Yilin Zheng
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, 010000, PR China
| | - Kun Wang
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, 010000, PR China
| | - Xiaotian Wang
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, PR China
| | - Juan Su
- School of Materials Science and Engineering, Inner Mongolia University of Technology, Hohhot, 010051, PR China.
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2
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Jiang L, Zhuang H, Song T, Li XQ. Clinical Outcomes at 3 Years After Stenting for Thrombotic and Non-thrombotic Iliac Vein Compression Syndrome Patients. Clin Appl Thromb Hemost 2024; 30:10760296231220053. [PMID: 38213124 PMCID: PMC10787525 DOI: 10.1177/10760296231220053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Iliac vein stenting for the treatment of iliac vein compression syndrome (IVCS) has been gradually developed. This article investigated the long-term patency and improvement of clinical symptoms after endovascular stenting for iliac vein obstruction patients. From 2020 to 2022, 83 patients at a single institution with IVCS underwent venous stent implantation and were divided into two groups: non-thrombotic IVCS (n = 55) and thrombotic IVCS (n = 28). The main stent-related outcomes include technical success, long-term patency, and thrombotic events. The technical success rate of all stent implantation was 100%. The mean length of hospital stay and cost were higher in the thrombotic IVCS group than in the non-thrombotic ICVS group, as well as the length of diseased vessel segment and the number of stents implanted were higher than in the control non-thrombotic group. The 1-, 2-, and 3-year patency rates were 85.4%, 80% and 66.7% in the thrombosis group, which were lower than 93.6%, 88.7%, and 87.5% in the control group (P = .0135, hazard ratio = 2.644). In addition, patients in both groups had a foreign body sensation after stent implantation, which resolved spontaneously within 1 year after surgery. Overall, there were statistically significant differences in long-term patency rate outcome between patients with thrombotic and non-thrombotic IVCS, the 1-, 2-, and 3-year patency rates in non-thrombotic IVCS patients were higher than those in thrombotic IVCS patients.
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Affiliation(s)
- Lei Jiang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Hao Zhuang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tao Song
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xiao-Qiang Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Vascular Surgery, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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3
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Elshinawy WE, Abdo EM, Farouk N, Abdelmohsen AA, Sakr LK, Abdo WH, Ali SMO. Effectiveness of Venous Stenting for the Treatment of Lower Extremity Chronic Thrombotic Venous Obstruction. Ann Vasc Surg 2022; 92:142-148. [PMID: 36581155 DOI: 10.1016/j.avsg.2022.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with venous hypertension (HTN) have significant morbidity and poor quality of life. Deep venous thrombosis (DVT) and congenital defects that led to chronic outflow blockage are frequent causes of venous HTN. It is known that the venovenous bypass has been the standard method used in the treatment of chronic iliofemoral vein occlusions. Percutaneous recanalization has earlier been shown to be technically possible. With venoplasty and stenting, we used an aggressive endovascular strategy to treat the iliofemoral venous thrombotic occlusion. METHODS From May 2019 to April 2021, the medical records were reviewed for 63 patients diagnosed with symptomatic iliofemoral thrombotic occlusive disease and treated with venous stenting. The procedures' results were analyzed at Al-Azhar University Hospitals. RESULTS The medical records of 63 cases (44 women with a median age of 49.52 years), with chronic outflow block of iliofemoral vein segment that were treated with endovascular venous stenting, were reviewed retrospectively. Optimal success was obtained in 56 cases (88.9%). The twelve-month primary, assisted primary, and secondary patency rates were 76.8%, 80.4%, and 87.5%, respectively, while it was 73.2%, 80.4%, and 87.5%, respectively, after 2 years. The procedure-related complication rate was 6.3%. Puncture site hematoma was observed in 2 patients (3.2%). Early (30 days) stent thrombosis occurred in 2 patients (3.2%). Most importantly, there was no procedure-related mortality. CONCLUSIONS Endovascular treatment with balloon angioplasty and stenting of chronic venous thrombotic occlusions is an effective and safe procedure associated with a high technical rate of success and excellent patency rates. Accordingly, it should be considered the first line in the treatment of symptomatic iliofemoral vein occlusion.
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Affiliation(s)
- Waleed E Elshinawy
- Vascular Surgery Department, Al-Azhar University, Faculty of Medicine (for Girls), Cairo, Egypt.
| | - Ehab M Abdo
- Vascular Surgery Department, Al-Azhar University, Faculty of Medicine (for Girls), Cairo, Egypt
| | - Nehal Farouk
- Vascular Surgery Department, Al-Azhar University, Faculty of Medicine (for Girls), Cairo, Egypt
| | | | - Lobna Kh Sakr
- Radiodiagnosis Department, Al-Azhar University, Faculty of Medicine (for Girls), Cairo, Egypt
| | - Walaa Husein Abdo
- Radiodiagnosis Department, Al-Azhar University, Faculty of Medicine (for Girls), Cairo, Egypt
| | - Sally Mohamed Osama Ali
- Radiodiagnosis Department, Al-Azhar University, Faculty of Medicine (for Girls), Cairo, Egypt
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Hendarso MR, Ghinorawa T, Aribowo H, Soerohardjo I. External iliac vein to inferior vena cava bypass as an alternative management for external iliac vein stenosis and thrombosis in renal transplant recipients. BMJ Case Rep 2022; 15:e245784. [PMID: 35609939 PMCID: PMC9131057 DOI: 10.1136/bcr-2021-245784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/04/2022] Open
Abstract
An man in his early 40s suffered from end-stage renal disease and underwent living donor renal transplantation. Doppler ultrasonography before surgery showed a normal iliac artery and vein without any thrombus. There was clear evidence of urine production intraoperatively. On the 5th postoperative day, there was no improvement in his renal function, and painless right leg oedema was noted. The clinical workup revealed pitting oedema without loss of arterial pulsation, discolouration or focal tenderness in the right leg. Serial Doppler ultrasonography examination showed thrombus progression from the right popliteal vein to the right external iliac vein around renal vein anastomosis despite anticoagulant administration with a downtrend of diuresis and worsening renal function. This condition led the patient to undergo surgical exploration on the 10th day post-transplantation. We decided to perform a thrombectomy and bypass the right external iliac vein to the inferior vena cava.
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Affiliation(s)
- Muhammad Radityo Hendarso
- Urology Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tanaya Ghinorawa
- Urology Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Haryo Aribowo
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Indrawarman Soerohardjo
- Urology Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Majeed GM, Lodhia K, Carter J, Kingdon J, Morris RI, Gwozdz A, Saratzis A, Saha P. A Systematic Review and Meta-Analysis of 12-Month Patency After Intervention for Iliofemoral Obstruction Using Dedicated or Non-Dedicated Venous Stents. J Endovasc Ther 2021; 29:478-492. [PMID: 34758673 PMCID: PMC9096580 DOI: 10.1177/15266028211057085] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular stenting of the deep venous system has been proposed as a method to treat patients with symptomatic iliofemoral outflow obstruction. The purpose of this systematic review and meta-analysis was to compare the effectiveness of this treatment at 1-year following the development of dedicated venous stents. METHOD AND RESULTS We searched MEDLINE and EMBASE for studies evaluating the effectiveness of venous stent placement. Data were extracted by disease pathogenesis: non-thrombotic iliac vein lesions (NIVL), acute thrombotic (DVT), or post-thrombotic syndrome (PTS). Main outcomes included technical success, stent patency at 1 year and symptom relief. A total of 49 studies reporting outcomes in 5154 patients (NIVL, 1431; DVT, 950; PTS, 2773) were included in the meta-analysis. Technical success rates were comparable among groups (97%-100%). There were no periprocedural deaths. Minor bleeding was reported in up to 5% of patients and major bleeding in 0.5% upon intervention. Transient back pain was noted in 55% of PTS patients following intervention. There was significant heterogeneity between studies reporting outcomes in PTS patients. Primary and cumulative patency at 1 year was: NIVL-96% and 100%; DVT-91% and 97%; PTS (stents above the ligament)-77% and 94%, and; PTS (stents across the ligament)-78% and 94%. There were insufficient data to compare patency outcomes of dedicated and nondedicated venous stents in patients with acute DVT. In NIVL and PTS patients, stent patency was comparable at 1 year. There was inconsistency in the use of validated tools for the measurement of symptoms before and after intervention. When reported, venous claudication, improved in 83% of PTS patients and 90% of NIVL patients, and ulcer healing occurred in 80% of PTS patients and 32% of NIVL patients. CONCLUSIONS The first generation of dedicated venous stents perform comparably in terms of patency and clinical outcomes to non-dedicated technologies at 1 year for the treatment of patients with NIVL and PTS. However, significant heterogeneity exists between studies and standardized criteria are urgently needed to report outcomes in patients undergoing deep venous stenting.
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Affiliation(s)
- Ghulam M Majeed
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Krishan Lodhia
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Jemima Carter
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Jack Kingdon
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Rachael I Morris
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Adam Gwozdz
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | | | - Prakash Saha
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
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Cohen CT, Kirk S, Desai SB, Kukreja KU, Srivaths L. Diagnosis, Clinical Characteristics, and Treatment Modalities of Adolescent May-Thurner Syndrome-associated Deep Venous Thrombosis. J Pediatr Hematol Oncol 2021; 43:e346-e350. [PMID: 33093351 DOI: 10.1097/mph.0000000000001968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/13/2020] [Indexed: 12/17/2022]
Abstract
May-Thurner syndrome (MTS) predisposes individuals to develop lower extremity deep venous thrombosis (DVT) because of compression of the left common iliac vein. Diagnosis of the anatomic obstruction is critical for effective therapy, as treatment by interventional radiology is often required in addition to anticoagulation to prevent thrombus progression and recurrence. The authors performed a retrospective review of adolescent patients who presented with MTS-associated DVT at a pediatric tertiary care center from 2009 to 2018 to assess for delays in MTS diagnosis after the presentation. Fourteen patients (median age 16.5 y, range, 13.8 to 17.9 y) were included, no DVTs were provoked by a central venous catheter. The median time from DVT to MTS diagnosis was 0.65 months (range, 0 to 21.5 mo). The initial imaging modalities used for DVT diagnosis were not able to diagnosis MTS. All patients were treated with anticoagulation and 13 underwent interventional therapy. Four patients had thrombus progression or recurrence, whereas 6 had complete thrombus resolution on follow-up imaging. Three patients who had a delayed MTS diagnosis had clinical worsening despite therapeutic anticoagulation requiring rehospitalization. Adolescent patients with "unprovoked" left lower extremity DVT should undergo appropriate imaging to diagnose MTS to allow for adequate medical and interventional therapy.
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Affiliation(s)
- Clay T Cohen
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers
| | - Susan Kirk
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers
| | - Sudhen B Desai
- Department of Radiology, Section of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Kamlesh U Kukreja
- Department of Radiology, Section of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Lakshmi Srivaths
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers
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7
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Notten P, ten Cate H, ten Cate‐Hoek AJ. Postinterventional antithrombotic management after venous stenting of the iliofemoral tract in acute and chronic thrombosis: A systematic review. J Thromb Haemost 2021; 19:753-796. [PMID: 33249698 PMCID: PMC7986750 DOI: 10.1111/jth.15197] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022]
Abstract
Venous stenting has become a common treatment option for central deep venous outflow obstructions and postthrombotic syndrome. Following successful recanalization and stenting, stent patency is endangered by in-stent thrombosis and recurrent venous thromboembolism. Antithrombotic therapy might reduce patency loss. This systematic review summarizes the literature on antithrombotic therapy following (post)thrombotic venous stenting. A systematic PubMed, MEDLINE, EMBASE, and Cochrane search was performed for studies addressing antithrombotic therapy prescribed following venous stenting of the iliofemoral tract indicated by acute or chronic thrombotic pathology. A total of 277 articles was identified of which 64 (56 original studies) were selected. Overall, a mean primary patency rate of 82.3% was seen 1 year after the intervention, which decreased to 73.3% after 2 years. In the majority (43 of 56 studies, 77%), treatment was based on use of vitamin K antagonists, either with (18%) or without (59%) use of antiplatelet drugs. Only two studies (4%) directly assessed the effect of antithrombotic therapy on treatment outcomes. The impact of postinterventional antithrombotic therapy on stent patency remains unknown because of limited and insufficient data available in current literature. Further clinical research should more clearly address the role of antithrombotic therapy for preservation of long-term patency following venous stenting.
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Affiliation(s)
- Pascale Notten
- Department of Vascular SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
- School for Cardiovascular DiseasesCARIM, Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Hugo ten Cate
- School for Cardiovascular DiseasesCARIM, Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
- Laboratory of Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
- Thrombosis Expertise CentreHeart Vascular CentreMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Arina J. ten Cate‐Hoek
- School for Cardiovascular DiseasesCARIM, Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
- Laboratory of Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
- Thrombosis Expertise CentreHeart Vascular CentreMaastricht University Medical CentreMaastrichtThe Netherlands
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8
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Li M, Zhang L, Zhang K, Zhu Y, Shi Z, Zhang W, Gao B, Li L, Fang Z, Yin L, Chen B, Liu Z. An efficacy and safety study of rivaroxaban for the prevention of deep vein thrombosis in patients with left iliac vein compression treated with stent implantation (PLICTS): study protocol for a prospective randomized controlled trial. Trials 2020; 21:811. [PMID: 32993773 PMCID: PMC7526216 DOI: 10.1186/s13063-020-04742-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balloon dilatation with stent implantation has been proved to be an effective option for left iliac vein compression syndrome (LIVCS), but thrombosis may still occur after the operation. Currently, warfarin is used for anticoagulant therapy, but long-term monitoring is required, while rivaroxaban does not need laboratory monitoring, which can simplify treatment. Therefore, this study aimed to compare the efficacy and safety of rivaroxaban and warfarin in anticoagulation. METHODS This study is a multicenter, randomized controlled trial. We will recruit 224 patients with thrombotic LIVCS from 9 hospitals. Moreover, these patients will be randomized to either the experimental group (rivaroxaban) or the control group (warfarin plus nadroparin). The primary outcome is stent occlusion rate. Secondary outcomes are quality of life scale survey results, all-cause mortality, anticoagulation-related mortality, and the proportion of participants with stent displacement/fracture, thrombosis, hemorrhage, and other vascular events. DISCUSSION This study will provide reliable, evidence-based clinical evidence for the efficacy and safety of rivaroxaban antithrombotic therapy after stent implantation. TRIAL REGISTRATION ClinicalTrials.gov NCT04067505 . Registered on August 26, 2019.
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Affiliation(s)
- Miaomiao Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China.,School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Libin Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Kaijie Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, 310016, China
| | - Yuefeng Zhu
- Department of Vascular Surgery, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, 310016, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital of Fudan University, Shanghai, 210023, China
| | - Wan Zhang
- Department of Vascular Surgery, Huadong Hospital of Fudan University, Shanghai, 210023, China
| | - Bin Gao
- Department of Vascular Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Lubin Li
- Department of Vascular Surgery, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Zhengdong Fang
- Department of Vascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - Li Yin
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Bing Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Zhenjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China.
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9
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Chen G, Wang Q, Chen Y, Wang X, Zhang X, Li X, Li F, Hu B, Chu H, Zheng D, Zhao W, Zhang H. The short-term outcome of residual thrombus of the lower extremity after pharmacomechanical catheter-directed thrombolysis for deep vein thrombosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1001. [PMID: 32953801 PMCID: PMC7475480 DOI: 10.21037/atm-20-5459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background This study aimed to assess the short-term effect of residual thrombus of the lower extremity after pharmacomechanical catheter-directed thrombolysis (PCDT) on the incidence of post-thrombotic syndrome (PTS) and iliofemoral vein patency rate in patients who underwent PCDT. Methods There were 94 continuous patients with severe deep vein thrombosis (DVT) of the lower extremities admitted to our hospital between March 2016 and June 2018; 73 cases receiving PCDT and verified with iliac vein compression syndrome (IVCS) were assigned into two groups. Thirty-nine patients without thrombus of the popliteal and infrapopliteal veins were assigned to the proximal DVT group. The remaining 34 cases were placed in the extensive DVT group. The thrombus scores, including venous registry index (VRI) score, Marder score, and Society for Vascular Surgery (SVS) score before and after PCDT, the primary two years’ cumulative rate of iliofemoral patency, and the rate of PTS, and complications were analyzed retrospectively. Results Ultimately, 27 patients in the proximal DVT group and 26 cases in the extensive DVT group completed the study. The two groups had no significant differences in terms of basic characteristics, complication and the rate of PTS (P>0.05). However, there were significant differences in terms of postoperative mean thrombus score and the mean degree of thrombosis removal score by Marder and SVS scores, residual thrombus by lower thrombosis classification (LET) and the two years’ cumulative iliofemoral vein patency rate (P<0.05). And the logistic regression analysis demonstrated the residual thrombus of LET class II [odds ratio (OR), 4.619, 95% confidence interval (CI), 1.090–19.567, P=0.038] was an independent risk factor for iliofemoral vein occlusion. Conclusions The residual thrombus of LET class II is an independent risk factor for iliofemoral vein occlusion. It is very important to keep the patency of the popliteal vein when deciding to use a stent to maintain iliofemoral vein patency. Furthermore, the anterior tibial vein approach and crisscross technique may be two important alternative methods that can be used to address the thrombus of popliteal vein for patients with extensive DVT.
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Affiliation(s)
- Guang Chen
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Qing Wang
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Yahong Chen
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Xiang Wang
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Xiaolong Zhang
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Xiang Li
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Fei Li
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Bin Hu
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Haiwei Chu
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Dexing Zheng
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Wenjun Zhao
- Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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10
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Salahuddin T, Armstrong EJ. Intervention for Iliofemoral Deep Vein Thrombosis and May-Thurner Syndrome. Interv Cardiol Clin 2020; 9:243-254. [PMID: 32147124 DOI: 10.1016/j.iccl.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
May-Thurner syndrome, also known as iliac vein compression syndrome, may cause symptoms of venous hypertension and is a predisposing factor for the development of iliofemoral deep vein thrombosis (DVT). Iliofemoral DVT is associated with high rates of development of postthrombotic syndrome, a potentially debilitating condition associated with development of symptoms related to venous outflow obstruction and resulting in reduced quality of life. In this Clinics article, we review procedural intervention with catheter-directed thrombolysis and stenting for iliofemoral DVT and iliac vein compression.
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Affiliation(s)
- Taufiq Salahuddin
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA
| | - Ehrin J Armstrong
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA; Interventional Cardiology, Vascular Laboratory, Rocky Mountain Regional VA, Division of Cardiology, University of Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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11
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J. Padrnos L, Garcia D. May-Thurner syndrome and thrombosis: A systematic review of antithrombotic use after endovascular stent placement. Res Pract Thromb Haemost 2019; 3:70-78. [PMID: 30656278 PMCID: PMC6332820 DOI: 10.1002/rth2.12156] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/27/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND May-Thurner Syndrome (MTS) is caused by compression of the left common iliac vein between the right common iliac artery and the pelvis. It likely predisposes an individual to lower extremity deep vein thrombosis (DVT) as well as symptoms of unilateral lower extremity swelling and discomfort in the absence of a known history of thrombosis. In the case of MTS-associated acute thrombosis, there is low-quality evidence to suggest that endovascular intervention including thrombolysis and endovascular stent placement reduces the risk of recurrent thrombosis. However, the optimal type and duration of antithrombotic therapy after stent placement for left iliofemoral vein stenosis is not known. METHODS A systematic literature search including studies that evaluated the outcome of endovascular stent occlusion and systemic anticoagulant use in patients with MTS associated DVT was performed. The primary outcome of interest was 12-month risk of endovascular stent occlusion or recurrent DVT. RESULTS A total of five studies encompassing 61 patients were included in our study. All studies were retrospective without a comparator group. A variety of anticoagulants and durations were prescribed. Of the 55 patients evaluable, the 12-month rate of endovascular stent occlusion or recurrent DVT ranged from 0% to 40%. The 12-month stent patency rate ranged from 60% to 100%. CONCLUSIONS The published evidence regarding antithrombotic treatment for patients with MTS who have undergone stent placement for a DVT is limited. Further high-quality, prospective studies are needed in this setting to inform clinical decision making.
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Affiliation(s)
| | - David Garcia
- Division of HematologyUniversity of WashingtonSeattleWashington
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12
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Mid-and long-term efficacy of endovascular-based procedures for Cockett syndrome. Sci Rep 2018; 8:12145. [PMID: 30108228 PMCID: PMC6092402 DOI: 10.1038/s41598-018-29756-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/12/2018] [Indexed: 12/21/2022] Open
Abstract
To investigate the mid- and long-term results of endovascular-based procedures for Cockett syndrome. The clinical data of 412 patients with Cockett syndrome treated between January 2003 and September 2017 were retrospectively analyzed. In these patients, 231 cases were acute left iliac femoral vein thrombosis (group A), and 181 cases were chronic venous insufficiency (group B), and different endovascular procedures and/or hybrid procedures were performed. In group A, the technique success rate was 100% (231/231); the left iliac vein in 5 patients showed no stenosis or occlusion, and the incidence of pathological changes in the left iliac vein was 97.8% (226/231); a total of 182 stents were implanted. In group B, the technique success rate was 99.4% (180/181); the average pressure difference between the proximal and distal portion of the pathological left iliac veins decreased from preoperative (18 ± 4.45) cmH2O to postoperative (4 ± 3.02) cmH2O (P < 0.01); 89 patients, complicated with valvular incompetence in the left superficial femoral vein, underwent a second-stage femoral valve repair. Follow-up ranged from 3 months to 8 years, with an average of 35.6 months, and intrastent thrombosis occurred in 15 cases of group A and in 2 cases of group B. Endovascular-based procedures offer favorable mid- and long-term results in treatment of Cockett syndrome, which in combination with Fogarty catheter thrombectomy or catheter-directed thrombolysis is a beneficial complementary treatment for patients with acute iliac femoral vein thrombosis.
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Taha MA, Busuttil A, Bootun R, Davies AH. A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb. Phlebology 2018; 34:115-127. [PMID: 29788818 DOI: 10.1177/0268355518772760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim is to evaluate venous stent patency, the development of post-thrombotic syndrome, recurrence, quality of life and the optimal post-procedural anticoagulation regimen in the treatment of iliofemoral deep venous thrombosis. METHOD AND RESULTS EMBASE and Medline databases were interrogated to identify studies in which acute deep venous thrombosis patients were stented. Twenty-seven studies and 542 patients were identified. Primary, assisted primary and secondary patency rates 12 months after stent placement ranged from 74 to 95, 90 to 95 and 84 to 100%, respectively. The observed post-thrombotic syndrome rate was 14.6%. The incidence of stent re-thrombosis was 8%. In 26% of studies, patients received additional antiplatelet therapy. Quality of life questionnaires employed in 11% of studies, demonstrating an improvement in the chronic venous insufficiency questionnaire (22.67 ± 3.01 versus 39.34 ± 6.66). CONCLUSION Venous stenting appears to be an effective adjunct to early thrombus removal; however, further studies are needed to identify optimal anticoagulant regimen and effect on quality of life.
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Affiliation(s)
- Mohamed Ah Taha
- 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK.,2 Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Andrew Busuttil
- 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - Roshan Bootun
- 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - Alun H Davies
- 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
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14
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Abstract
Lower extremity deep venous thrombosis is a leading cause of morbidity and mortality. The mainstay of therapy is medical. However, anticoagulation does not remove the thrombus and restore venous patency. In select patients, early thrombus removal and anticoagulation can restore venous patency, preserve venous valve function, and may reduce the incidence of postthrombotic syndrome. Catheter-directed therapies are minimally invasive with low complication rates. However, in patients with a contraindication to thrombolytic agents who can receive anticoagulation, open thrombectomy should be considered if indications for thrombus removal are met and patients are good operative risks.
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15
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Abstract
Venous compression syndromes occur due to extrinsic compression causing complications of venous hypertension or venous thrombosis. This review focuses on 4 venous compression syndromes involving the left common iliac vein, subclavian vein, left renal vein, and popliteal vein. Clinical presentation, diagnostic methods, and management options are reviewed. When properly diagnosed and treated, long-term consequences can be avoided.
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Affiliation(s)
- Joseph M White
- 1 The Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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16
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Common iliac vein thrombosis as a result of proximal venous stenosis following renal transplantation: A case report. TRANSPLANTATION REPORTS 2016. [DOI: 10.1016/j.tpr.2016.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Min SK, Kim YH, Joh JH, Kang JM, Park UJ, Kim HK, Chang JH, Park SJ, Kim JY, Bae JI, Choi SY, Kim CW, Park SI, Yim NY, Jeon YS, Yoon HK, Park KH. Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines. Vasc Specialist Int 2016; 32:77-104. [PMID: 27699156 PMCID: PMC5045251 DOI: 10.5758/vsi.2016.32.3.77] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 01/28/2023] Open
Abstract
Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.
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Affiliation(s)
- Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Hwan Kim
- Department of Radiology, Keimyung University College of Medicine, Daegu,
Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Jin Mo Kang
- Department of Surgery, Gachon University College of Medicine, Incheon,
Korea
| | - Ui Jun Park
- Department of Surgery, Keimyung University College of Medicine, Daegu,
Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu,
Korea
| | - Jeong-Hwan Chang
- Department of Surgery, Chosun University College of Medicine, Gwangju,
Korea
| | - Sang Jun Park
- Department of Surgery, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jang Yong Kim
- Department of Surgery, Catholic University College of Medicine,
Korea
| | - Jae Ik Bae
- Mint Intervention Clinic, Seongnam,
Korea
| | - Sun Young Choi
- Department of Radiology, Ewha Womans University College of Medicine, Seoul,
Korea
| | - Chang Won Kim
- Department of Radiology, Pusan National University School of Medicine, Yangsan,
Korea
| | - Sung Il Park
- Department of Radiology, Yonsei University College of Medicine, Seoul,
Korea
| | - Nam Yeol Yim
- Department of Radiology, Chonnam National University College of Medicine, Gwangju,
Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University College of Medicine, Incheon,
Korea
| | - Hyun-Ki Yoon
- Department of Radiology, University of Ulsan College of Medicine, Seoul,
Korea
| | - Ki Hyuk Park
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu,
Korea
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Jiang K, Li XQ, Sang HF, Qian AM, Rong JJ, Li CL. Mid-term outcome of endovascular treatment for acute lower extremity deep venous thrombosis. Phlebology 2016; 32:200-206. [PMID: 27022012 DOI: 10.1177/0268355516640370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purposes of the study To evaluate the benefit of stenting the iliac vein in patients with residual iliac vein stenosis treated with catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis. Procedures In this randomized prospective study, patients with a first-time acute lower extremity deep venous thrombosis that had persisted <14 days were treated with catheter-directed thrombolysis. After catheter-directed thrombolysis, patients with >50% residual iliac vein stenosis were randomly divided into two groups: catheter-directed thrombolysis + Stent Group and catheter-directed thrombolysis Alone Group. Patients received urokinase thrombolysis and low-molecular-weight heparin/oral warfarin during the hospitalization period and were administrated oral warfarin after discharge. Cumulative deep vein patency, the Clinical Etiology Anatomic Pathophysiologic classification system, the Venous Clinical Severity Score and the Chronic Venous Insufficiency Questionnaire score were evaluated. Findings The cumulative deep vein patency rate was 74.07% in the catheter-directed thrombolysis + Stent Group and 46.59% in the catheter-directed thrombolysis Alone Group. The mean postoperative Clinical Etiology Anatomic Pathophysiologic classification and Venous Clinical Severity Score was significantly lower in the catheter-directed thrombolysis + Stent Group than in the catheter-directed thrombolysis Alone Group. The mean postoperative Chronic Venous Insufficiency Questionnaire score was significantly higher in the catheter-directed thrombolysis + Stent Group than the catheter-directed thrombolysis Alone Group. Conclusions Placement of an iliac vein stent in patients with residual iliac vein stenosis after catheter-directed thrombolysis for acute lower extremity deep venous thrombosis increases iliac vein patency and improves clinical symptoms and health-related quality of life at mid-term follow-up compared to patients treated with catheter-directed thrombolysis alone.
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Affiliation(s)
- Kun Jiang
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Xiao-Qiang Li
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Hong-Fei Sang
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Ai-Min Qian
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Jian-Jie Rong
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Cheng-Long Li
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
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Razavi MK, Jaff MR, Miller LE. Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction: Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2016; 8:e002772. [PMID: 26438686 DOI: 10.1161/circinterventions.115.002772] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Endovenous recanalization of iliofemoral stenosis or occlusion with angioplasty and stent placement has been increasingly used to maintain long-term venous patency in patients with iliofemoral venous outflow obstruction. The purpose of this systematic review and meta-analysis was to determine safety and effectiveness of venous stent placement in patients with iliofemoral venous outflow obstruction. METHODS AND RESULTS We searched MEDLINE and EMBASE for studies evaluating safety or effectiveness of stent placement in patients with iliofemoral venous outflow obstruction. Data were extracted by disease pathogenesis: nonthrombotic, acute thrombotic, or chronic post-thrombotic. Main outcomes included technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years. A total of 37 studies reporting 45 treatment effects (nonthrombotic, 8; acute thrombotic, 19; and chronic post-thrombotic, 18) from 2869 patients (nonthrombotic, 1122; acute thrombotic, 629; and chronic post-thrombotic, 1118) were included. Technical success rates were comparable among groups, ranging from 94% to 96%. Complication rates ranged from 0.3% to 1.1% among groups for major bleeding, from 0.2% to 0.9% for pulmonary embolism, from 0.1% to 0.7% for periprocedural mortality, and from 1.0% to 6.8% for early thrombosis. Patient symptom relief data were reported inconsistently. At 1 year, primary and secondary patency were 96% and 99% for nonthrombotic, 87% and 89% for acute thrombotic, and 79% and 94% for chronic post-thrombotic. CONCLUSIONS Stent placement for iliofemoral venous outflow obstruction results in high technical success and acceptable complication rates regardless of cause of obstruction.
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Affiliation(s)
- Mahmood K Razavi
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.).
| | - Michael R Jaff
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.)
| | - Larry E Miller
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.)
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20
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Mumme A, Hummel T. Rekanalisierende Therapie der tiefen Bein-/Beckenvenenthrombose. GEFÄSSCHIRURGIE 2016. [DOI: 10.1007/s00772-016-0119-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Haig Y, Enden T, Grøtta O, Kløw NE, Slagsvold CE, Ghanima W, Sandvik L, Hafsahl G, Holme PA, Holmen LO, Njaaastad AM, Sandbæk G, Sandset PM. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. LANCET HAEMATOLOGY 2016; 3:e64-71. [PMID: 26853645 DOI: 10.1016/s2352-3026(15)00248-3] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Post-thrombotic syndrome is a common complication after acute proximal deep vein thrombosis (DVT) and is associated with reduced quality of life and a substantial cost burden. In the 2-year results of the CaVenT study, additional catheter-directed thrombolysis reduced the risk of post-thrombotic syndrome by 14% compared with conventional therapy, but did not affect quality of life. In this study we report results at the 5-year follow-up, aiming to assess whether findings for post-thrombotic syndrome and quality of life have persisted. METHODS Between Jan 3, 2006, and Dec 22, 2009, we recruited patients aged 18-75 years with a first-time high proximal leg DVT from 20 hospitals in the Norwegian southeastern health region. With sealed envelopes, participants were randomly assigned (1:1) to standard treatment with compression stockings and anticoagulants (control group) or to standard treatment plus catheter-directed thrombolysis with alteplase within 21 days from symptom onset. Pre-specified outcomes in this analysis were post-thrombotic syndrome at 5 years as assessed with the Villalta score and scores for quality of life at 5 years with EQ-5D and the disease-specific VEINES-QOL/Sym. Analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00251771. FINDINGS At 5 year follow-up (last date Oct 14, 2014), data were available for 176 patients (84% of the 209 patients originally randomised)--87 originally assigned to catheter-directed thrombolysis and 89 originally assigned to the control group. 37 patients (43%; 95% CI 33-53) allocated to catheter-directed thrombolysis developed post-thrombotic syndrome, compared with 63 (71%; 95% CI 61-79) allocated to the control group (p<0·0001), corresponding to an absolute risk reduction of 28% (95% CI 14-42) and a number needed to treat of 4 (95% CI 2-7). Four (5%) patients assigned to catheter-directed thrombolysis and one (1%) to standard treatment had severe post-thrombotic syndrome (Villalta score ≥ 15 or presence of an ulcer). Quality-of-life scores with either assessment scale did not differ between the treatment groups. INTERPRETATION Additional catheter-directed thrombolysis resulted in a persistent and increased clinical benefit during follow-up for up to 5 years, supporting the use of additional catheter-directed thrombolysis in patients with extensive proximal DVT. However, allocation to this therapy did not lead to better quality of life. The optimal endovascular thrombolytic approach needs further investigation. FUNDING Southeastern Norway Regional Health Authority, the Research Council of Norway, University of Oslo, Oslo University Hospital.
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Affiliation(s)
- Ylva Haig
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Tone Enden
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ole Grøtta
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Nils-Einar Kløw
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Waleed Ghanima
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway
| | - Leiv Sandvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Hafsahl
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål Andre Holme
- Department of Haematology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Olaf Holmen
- Department of Radiology, Østfold Hospital Trust, Fredrikstad, Norway
| | | | - Gunnar Sandbæk
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Abstract
The conservative treatment of deep leg and pelvic vein thrombosis leads to permanent damage of recanalised veins, which in cases of long distance clots as well as involvement of the pelvic level, increase the risk of developing a postthrombotic syndrome. Such subsequent damage of the deep veins can only be avoided if occluded veins are rapidly recanalised and the function of the valves is successfully reestablished. Recanalisation may consist of surgical, fibrolytic and interventional methods and aims to minimize any subsequent damage; however no potential benefit of recanalisation versus standard treatment has yet been proven by means of methodologically adequate comparative studies. Thus, the indications for recanalisation must remain strict and be founded on a thorough risk-benefit assessment.
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Affiliation(s)
- A Mumme
- Klinik für Gefäßchirurgie, Katholisches Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland,
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Venous stenting after deep venous thrombosis and antithrombotic therapy: A systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rvm.2014.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Gastambide Norbis M, Martín Pedrosa M, Gutiérrez Alonso V, San Norberto E, Vaquero Puerta C. Tratamiento endovascular de trombosis venosa iliocava secundaria a compresión por mioma gigante. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2013.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Azarbal A, Santo V, Moneta G. How should we treat May–Thurner syndrome and other causes of iliac vein obstruction? Examining the evidence. Interv Cardiol 2014. [DOI: 10.2217/ica.13.85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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26
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Mumme A, Hummel T. Die multimodale operative Therapie der tiefen Beinvenenthrombose. GEFÄSSCHIRURGIE 2013. [DOI: 10.1007/s00772-013-1211-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park JY, Ahn JH, Jeon YS, Cho SG, Kim JY, Hong KC. Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May–Thurner syndrome. Phlebology 2013; 29:461-70. [DOI: 10.1177/0268355513491724] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction This study aims to evaluate the primary patency and clinical outcomes after stenting for residual iliac venous stenosis during catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis arising from May–Thurner syndome. Methods A retrospective study was done for the all patients who underwent iliac vein stenting after catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis due to May–Thurner syndrome from January 2005 to April 2011 in Inha University Hospital. Patient information was assembled from the electronic medical records, imaging and interview. The patency of iliac vein stent was evaluated with serial computed tomography. Results Fifty-one patients were enrolled. The median age was 70 years (range 44–86). There were 37 females (72.5%). The duration of symptoms of acute deep vein thrombosis before catheter-directed thrombolysis treatment was 6 days (median, range 1–33). Self-expanding stent was used for iliac vein stenting. Initial technical success rate was 94.1%. There were two complications (3.9%): an arteriovenous fistula formation in left popliteal area and a right inguinal hematoma. Mean follow-up was 15.6 months (range 6 days–80.8 months). Primary patency rate after iliac vein stenting was 95.8% at 6 months, 87.5% at 12 months and 84.3% at 24 months. Four patients had recurrent thrombotic occlusion (7.8%) during the follow-up. Conclusion Iliac vein stenting showed good primary patency rate with few complications. Iliac vein stenting is a durable option for residual stenosis after catheter-directed thrombolysis treatment of acute deep vein thrombosis in May–Thurner syndrome.
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Affiliation(s)
- Jae Young Park
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Jong Hyuk Ahn
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Jang Yong Kim
- Division of Vascular Surgery, Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
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La Spada M, Stilo F, Carella G, Salomone I, Benedetto F, De Caridi G, Spinelli F. Thrombectomy and surgical reconstruction for extensive iliocaval thrombosis in a patient with agenesis of the retrohepatic vena cava and atresia of the left renal vein. Ann Vasc Surg 2011; 25:839.e1-4. [PMID: 21620663 DOI: 10.1016/j.avsg.2010.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 06/16/2010] [Accepted: 12/27/2010] [Indexed: 11/19/2022]
Abstract
In 80% of the patients presenting with deep-venous thrombosis (DVT), a risk factor can be identified. An absent or hypoplastic infrarenal vena cava is a rare risk factor for DVT in young adults. In these cases, the prevalence of congenital anomalies of the inferior vena cava (IVC) is estimated at 0.5% of the general population, up to 5% in young people. The association with coagulopathy increases the risk of DVT. We report a case of a young man who presented with a massive caval and iliofemoral-popliteal thrombosis in presence of the agenesis of retrohepatic inferior vena cava and atresia of the left renal vein. Open thrombectomy and caval reconstruction with a polytetrafluoroethylene graft were performed. Surgical option with vein reconstruction was preferred to prevent new episodes of thrombosis and the risk of acute renal failure.
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Affiliation(s)
- Michele La Spada
- Unit of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, University of Messina, Italy
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29
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Karthikesalingam A, Young E, Hinchliffe R, Loftus I, Thompson M, Holt P. A Systematic Review of Percutaneous Mechanical Thrombectomy in the Treatment of Deep Venous Thrombosis. Eur J Vasc Endovasc Surg 2011; 41:554-65. [DOI: 10.1016/j.ejvs.2011.01.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/10/2011] [Indexed: 12/16/2022]
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30
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Titus JM, Moise MA, Bena J, Lyden SP, Clair DG. Iliofemoral stenting for venous occlusive disease. J Vasc Surg 2011; 53:706-12. [DOI: 10.1016/j.jvs.2010.09.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/31/2010] [Accepted: 09/02/2010] [Indexed: 10/18/2022]
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May-Thurner Syndrome Complicated by Acute Iliofemoral Vein Thrombosis: Helical CT Venography for Evaluation of Long-Term Stent Patency and Changes in the Iliac Vein. AJR Am J Roentgenol 2010; 195:751-7. [DOI: 10.2214/ajr.09.2793] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Patterson BO, Hinchliffe R, Loftus IM, Thompson MM, Holt PJE. Indications for catheter-directed thrombolysis in the management of acute proximal deep venous thrombosis. Arterioscler Thromb Vasc Biol 2010; 30:669-74. [PMID: 20237328 DOI: 10.1161/atvbaha.109.200766] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deep vein thromboses (DVTs) cause significant morbidity and mortality in the general population. Oral anticoagulation therapy may reduce thrombus propagation but does not cause clot lysis and therefore does not prevent postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) can be used to treat DVTs as an adjunct to medical therapy, but there is no consensus defining exact indications. Current evidence suggests that CDT can reduce clot burden and DVT recurrence and consequently prevents the formation of PTS compared with systemic anticoagulation. Appropriate indications include younger individuals with acute proximal thromboses, a long life expectancy, and relatively few comorbidities. Limb-threatening thromboses may also be treated with CDT, although the subsequent mortality remains high. A number of randomized controlled trials are currently under way comparing the longer-term outcomes of CDT compared with anticoagulation alone. Initial reports suggest that venous patency and valvular function are better maintained after CDT. The effectiveness of combined pharmacomechanical thrombectomy and the role of vena cava filters need to be investigated further before strong recommendations can be made. The reported short-term outcomes following catheter-based intervention for DVT are encouraging in selected patients. Further evidence is required to establish long-term benefits and cost-effectiveness.
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Affiliation(s)
- Benjamin O Patterson
- St. George's Vascular Institute, St. George's Hospital NHS Trust, Blackshaw Road, London SW17 OQT, United Kingdom
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Jeon YS, Yoon YH, Cho JY, Baek WK, Kim KH, Hong KC, Kim JT. Catheter-directed thrombolysis with conventional aspiration thrombectomy for lower extremity deep vein thrombosis. Yonsei Med J 2010; 51:197-201. [PMID: 20191009 PMCID: PMC2824863 DOI: 10.3349/ymj.2010.51.2.197] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 05/26/2009] [Accepted: 07/07/2009] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate treatment outcomes in patients with symptomatic deep vein thrombosis (DVT) who had undergone a catheter-directed thrombolysis with conventional aspiration thrombectomy for the treatment of lower extremity deep vein thrombosis. MATERIALS AND METHODS The authors retrospectively reviewed the records of 74 patients (mean age 61 +/- 15) that underwent a catheter-directed thrombolysis with conventional aspiration thrombectomy. A retrieval inferior vena cava (IVC) filter was placed to protect against a pulmonary embolism in 60 patients (81%). Stenting and balloon angioplasty were performed in 37 patients (50%) under the left common iliac vein compression. RESULTS Sixty-seven patients (91%) showed a clinical improvement within 48 hours, but seven patients (9%) showed no improvement. Multi detector computerized tomographic venography (MDCT venography) at discharge showed no thrombus in 15 patients (20%) and partial thrombus in 52 (70%). Twenty-eight patients (38%) developed post-thrombotic syndrome at 3.0 +/- 4.2 months postoperatively. Six patients (8%) were admitted due to DVT recurrence at a mean of 5.6 +/- 7.4 months postoperatively. Sixty-nine patients underwent follow up MDCT venography at 5.7 +/- 5.6 months. fifty (72%) of these showed no thrombus, 15 (22%) partial thrombus, and 4 (6%) showed obstruction. Twenty-eight of 61 (46%) were asymptomatic, twenty-eight (46%) had moderate improvement, and four (6%) were mildly improved by a telephone interview (81%) at 22.8 +/- 10.7 months postoperatively. CONCLUSION Catheter-directed thrombolysis with conventional aspiration thrombectomy is an effective treatment for lower extremity deep vein thrombosis and produces satisfactory clinical results.
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Affiliation(s)
- Yong Sun Jeon
- Department of Radiology, Inha University Hospital, Incheon, Korea
| | - Yong Han Yoon
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
| | - Joung Ym Cho
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
| | - Wan Ki Baek
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
| | - Kwang Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
| | - Kee Chun Hong
- Department of General Surgery, Inha University Hospital, Incheon, Korea
| | - Joung Taek Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea
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Moudgill N, Hager E, Gonsalves C, Larson R, Lombardi J, DiMuzio P. May-Thurner syndrome: case report and review of the literature involving modern endovascular therapy. Vascular 2010; 17:330-5. [PMID: 19909680 DOI: 10.2310/6670.2009.00027] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
May-Thurner syndrome is a rare clinical entity involving venous obstruction of the left lower extremity. Obstruction occurs secondary to compression of the left common iliac vein between the right common iliac artery and the underlying vertebral body. Current management largely involves endovascular therapy. A review was conducted of six studies containing at least five patients with May-Thurner syndrome treated by endovascular therapy. We compiled data on 113 patients, analyzing patient demographics, treatment details, and outcome. An 18-year-old female presented 1 week after the onset of left lower extremity pain and swelling. Duplex ultrasonography revealed extensive left-sided deep venous thrombosis (DVT). Thrombolysis followed by iliac vein stent placement restored patency to the venous system, with subsequent resolution of symptoms. Review of 113 patients revealed that the majority were females (72%) presenting with DVT (77%), most of which was acute in onset (73%). Therapy consisted of catheter-directed thrombolysis and subsequent stent placement in the majority of patients, resulting in a mean technical success of 95% and a mean 1-year patency of 96%. Endovascular therapy is the current mainstay of treatment for May-Thurner syndrome. Review of the current literature supports treatment via catheter-directed thrombolysis followed by stent placement with good early results.
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Affiliation(s)
- Neil Moudgill
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Allaqaband S, Kirvaitis R, Jan F, Bajwa T. Endovascular treatment of peripheral vascular disease. Curr Probl Cardiol 2009; 34:359-476. [PMID: 19664498 DOI: 10.1016/j.cpcardiol.2009.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peripheral arterial disease (PAD) affects about 27 million people in North America and Europe, accounting for up to 413,000 hospitalizations per year with 88,000 hospitalizations involving the lower extremities and 28,000 involving embolectomy or thrombectomy of lower limb arteries. Many patients are asymptomatic and, among symptomatic patients, atypical symptoms are more common than classic claudication. Peripheral arterial disease also correlates strongly with risk of major cardiovascular events, and patients with PAD have a high prevalence of coexistent coronary and cerebrovascular disease. Because the prevalence of PAD increases progressively with age, PAD is a growing clinical problem due to the increasingly aged population in the United States and other developed countries. Until recently, vascular surgical procedures were the only alternative to medical therapy in such patients. Today, endovascular practice, percutaneous transluminal angioplasty with or without stenting, is used far more frequently for all types of lower extremity occlusive lesions, reflecting the continuing advances in imaging techniques, angioplasty equipment, and endovascular expertise. The role of endovascular intervention in the treatment of limb-threatening ischemia is also expanding, and its promise of limb salvage and symptom relief with reduced morbidity and mortality makes percutaneous transluminal angioplasty/stenting an attractive alternative to surgery and, as most endovascular interventions are performed on an outpatient basis, hospital costs are cut considerably. In this monograph we discuss current endovascular intervention for treatment of occlusive PAD, aneurysmal arterial disease, and venous occlusive disease.
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Gogalniceanu P, Johnston C, Khalid U, Holt P, Hincliffe R, Loftus I, Thompson M. Indications for Thrombolysis in Deep Venous Thrombosis. Eur J Vasc Endovasc Surg 2009; 38:192-8. [DOI: 10.1016/j.ejvs.2009.03.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 03/18/2009] [Indexed: 12/31/2022]
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Murphy EH, Davis CM, Journeycake JM, DeMuth RP, Arko FR. Symptomatic ileofemoral DVT after onset of oral contraceptive use in women with previously undiagnosed May-Thurner Syndrome. J Vasc Surg 2009; 49:697-703. [PMID: 19135831 DOI: 10.1016/j.jvs.2008.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 09/23/2008] [Accepted: 10/04/2008] [Indexed: 01/02/2023]
Abstract
OBJECTIVE May-Thurner syndrome is characterized by left common iliac obstruction secondary to compression of the left iliac vein by the right common iliac artery against the fifth-lumbar vertebra. This anatomic variant results in an increased incidence of left-sided deep venous thrombosis (DVT). Furthermore, while a preponderance of left-sided DVT has been demonstrated in women during pregnancy and oral contraceptive use, patients are not typically screened for this condition after developing a left-sided DVT. As anticoagulation alone is ineffective for DVT treatment in the setting of May-Thurner anatomy, more aggressive treatment is warranted. Failure to diagnosis this condition predisposes these women to the unnecessary risks of recurrent DVT and post-thrombotic syndrome. METHODS We present the occurrence of 7 adolescent patients with previously undiagnosed May-Thurner syndrome who presented with DVT after the initiation of oral contraceptive steroids (OCP) use. All 7 patients elected to proceed with mechanical thrombolysis/catheter based thrombolysis followed by endovascular stenting and were postoperatively treated with 6 months of warfarin. RESULTS Mean patient age was 18.3 +/- 3.3 years (range, 16-24 years). Mean time to presentation after initiation of OCP was 5 weeks (range, 2-10 weeks). Mean time to intervention was 16.8 days (range, 10-24 days). All patients were treated with mechanical thrombectomy. Our rate of intraoperative clot resolution was 100%. All 7 patients were treated with self expanding nitinol stents after angioplasty of the iliac vein stenosis with resolution of the stenotic segment. Primary stent patency is 100% (7/7). Mean follow-up time is 13 +/- 13.84 months (range, 6-42 months). There have been no long-term complications related to surgical treatment or anticoagulation. All 7 patients have experienced resolution of left leg swelling and pain and have no evidence of post-thrombotic syndrome or DVT recurrence to date. CONCLUSIONS Women on OCPs presenting with left-sided iliofemoral DVT should be screened for hypercoagulable disorders and underlying May-Thurner anatomy. Treatment of May-Thurner syndrome should include thrombolysis/thrombectomy and anticoagulation for current DVT in addition to angioplasty and stenting of the underlying obstruction.
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Affiliation(s)
- Erin H Murphy
- Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA
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Late results of surgical venous thrombectomy with iliocaval stenting. J Vasc Surg 2008; 47:381-7. [PMID: 18241761 DOI: 10.1016/j.jvs.2007.10.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 10/09/2007] [Accepted: 10/10/2007] [Indexed: 01/02/2023]
Abstract
PURPOSE Iliac vein occlusive disease leads to 73% of rethrombosis that occurs after venous thrombectomy when left untreated. The goal of this study is to present our long-term results of stenting of iliocaval occlusive lesions persisting after surgical venous thrombectomy. METHODS From November 1995 to April 2007, 29 patients (19 women), with a median age of 38 years, had surgical venous thrombectomy with creation of an arteriovenous fistula and angioplasty and stenting. All were admitted for acute (<10 days) deep venous thrombosis (DVT) involving the iliocaval segment, of which eight had concomitant acute pulmonary embolism. Six patients had a history of DVT (2 with previous venous thrombectomy), two were pregnant, and three had postpartum DVT. No patients had short- or mid-term life-threatening factors. The underlying lesion was left iliocaval compression (May-Thurner syndrome) in 22 patients, chronic left common iliac vein occlusion in 3, residual clot in 3, and compression of the left external iliac vein by the left internal iliac artery in 1. RESULTS Neither perioperative death nor pulmonary embolism occurred. Four early complications occurred after stenting (13.8%). Median hospital length of stay was 8 days (range, 5-22 days). Median follow-up was 63 months (range, 2-137 months). Three late complications occurred (10.3 %): one rethrombosis due to stent crushing during pregnancy and two restenosis, which were treated by iterative stenting. At the end of the follow-up, the median venous clinical severity score was 3 (range 1-12) and the venous disability score was 1 (range 0-2). Primary, assisted primary and secondary patency rates were, respectively, 79%, 86%, and 86% at 12, 60, and 120 months. Patients with patent iliocaval segments had significantly fewer infrainguinal obstructive lesions (4% vs 50%) and a higher rate of valvular competence (76% vs 0%) than those who experienced rethrombosis. Venous scores were also worse in patients with rethrombosis. CONCLUSION Stenting is a safe, efficient, and durable technique to treat occlusive iliocaval disease after venous thrombectomy. Its use can prevent most of the rethrombosis that occurs after venous thrombectomy without major adverse effects.
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