Surgical Repair of Iliofemoral Venous Segment in Patients with Post-Thrombotic Syndrome

Popova IV, Mitrofanov VO, Rabtsun AA, et al. . Surgical Repair of Iliofemoral Venous Segment in Patients with Post-Thrombotic Syndrome. Journal of Venous Disorders. 2020;14(4):258‑265. (In Russ.)
https://doi.org/10.17116/flebo202014041258

Подписка 2026 Флебология (Journal of Venous Disorders)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To evaluate safety and efficacy of surgical repair of iliofemoral venous segment with and without arteriovenous fistula (AVF) from native vessels in patients with post-thrombotic syndrome (PTS).

MATERIAL AND METHODS

Hybrid surgery (iliac vein stenting with endophlebectomy from the common femoral vein and AVF between the branch or trunk of the great saphenous vein and common femoral artery) was performed in 7 patients (group 1). Nineteenth (group 2) underwent percutaneous recanalization with stenting of the iliofemoral segment. A telephone survey was carried out in long-term period (after 12 months). Safety was determined by mortality, presence or absence of symptoms of pulmonary embolism (PE), myocardial infarction (MI), stroke. Effectiveness of treatment comprised of technical success of surgery (patent segment) and reduced symptoms of PTS in postoperative period.

RESULTS

Technical success of surgery was achieved in 100% of cases in both groups. Mortality, pulmonary embolism, MI and stroke were absent for the entire follow-up period. Occlusion of segment in early postoperative period was found in 2 (28.5%) patients of the 1st group and 1 (5.26%) patient of the 2nd group. Overall patency of segment with AVF was 57%, without AVF — 79% (p=0.23). Reduced pain and lower extremity edema were noted in both groups. In group 2, trophic ulcer healing was observed in 2 cases.

CONCLUSION

Surgical repair of iliofemoral venous segment with and without AVF is effective and safe in patients with PTS. AV fistula does not improve patency of venous segment.

Keywords:

post-thrombotic syndrome

chronic venous insufficiency

CEAP

hybrid surgery

stenting

Authors:

Popova I.V.

Meshalkin National Medical Research Center

Scopus AuthorID: 56770803900
ORCID: 0000-0002-6911-4650

Mitrofanov V.O.

Meshalkin National Medical Research Center

ORCID: 0000-0003-4032-9217

Rabtsun A.A.

Meshalkin National Medical Research Center

Scopus AuthorID: 57192282075
ORCID: 0000-0003-2803-5937

Saaya Sh.B.

Meshalkin National Medical Research Center

Scopus AuthorID: 57192153358
ORCID: 0000-0001-6547-6948

Ignatenko P.V.

Meshalkin National Medical Research Center

ORCID: 0000-0001-8695-0848

Cheban A.V.

Meshalkin National Medical Research Center

ORCID: 0000-0002-6094-4607

Starodubtsev V.B.

Meshalkin National Medical Research Center

ORCID: 0000-0002-4913-614X

Karpenko A.A.

Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation

ORCID: 0000-0001-6914-334X

Popov V.V.

Novosibirsk State University

ORCID: 0000-0003-3082-2315

Received:

29.09.2019

Accepted:

19.04.2020

Close metadata

References:

Akesson H, Brudin L, Dahlstrom JA, Eklöf B, Ohlin P, Plate G. Venous function assessed during a 5-year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg. 1990;4(1):43-48. https://doi.org/10.1016/s0950-821x(05)80037-4
Colledge-Smith PD. The aethiology and pathophysiology of chronic venous insufficiency and leg ulcers. In: Johnson CD, Taylor I. Recent advances in surgery. Edinburg: Churchill Livingstone; 2000.
Johnson BF, Manzo RA, Bergelin RO, Strandness DE Jr. Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one- to six-year follow-up. J Vasc Surg. 1995;21(2):307-312. https://doi.org/10.1016/s0741-5214(95)70271-7
Haenen JH, Janssen MC, van Langen H, van Asten WN, Wollersheim H, van’t Hof MA, Skotnicki SH, Thien T. The postthrombotic syndrome in relation to venous hemodynamics, as measured by means of duplex scanning and strain-gauge plethysmography. J Vasc Surg. 1999;29:1071-1076. https://doi.org/10.1016/s0741-5214(99)70248-x
Kahn SR, Shapiro S, Wells PS, Rodger MA, Kovacs MJ, Anderson DR, Tagalakis V, Houweling AH, Ducruet T, Holcroft C, Johri M, Solymoss S, Miron M-J, Yeo E, Smith R, Schulman S, Kassis J, Kearon C, Chagnon I, Wong T, Demers C, Hanmiah R, Kaatz S, Selby R, Rathbun S, Desmarais S, Opatrny L, Ortel TL, Ginsberg JS; SOX Trial Investigators. Compression stockings to prevent post-thrombotic syndrome: a randomised placebocontrolled trial. Lancet. 2014;383:880-888. https://doi.org/10.1016/S0140-6736(13)61902-9
O’Donnell TF Jr, Browse NL, Burnand DG, Thomas ML: The socioeconomic effects of iliofemoral venous thrombosis. J Surg Res. 1977;22:483-488. https://doi.org/10.1016/0022-4804(77)90030-0
Yamaki T, Nozaki M, Sakurai H, Takeuchi M, Soejima K, Kono T. High peak reflux velocity in the proximal deep veins is a strong predictor of advanced post-thrombotic sequelae. J Thromb Haemost. 2007;5:305-312. https://doi.org/10.1111/j.1538-7836.2007.02345.x
Van Vuuren TM, Kurstjens RL, de Wolf MA, van Laanen JH, Wittens CH, de Graaf R. Stent extension into a single inflow vessel is a valuable option after endophlebectomy. Phlebology. 2018;33(9):610-617. https://doi.org/10.1177/0268355517739766
Pokrovsky A, Ignatyev I, Gradusov E. First Experience of Performing Hybrid Operations in Chronic Venous Obstructions of Iliofemoral Segments in Patients With Postthrombotic Syndrome. Vasc Endovascular Surg. 2017;51(7):447-452. https://doi.org/10.1177/1538574417717609
Vogel D, Comerota AJ, Al-Jabouri M, Assi ZI. Common femoral endovenectomy with iliocaval endoluminal recanalization improves symptoms and quality of life in patients with postthrombotic iliofemoral obstruction. J Vasc Surg. 2012;55(1):129-135. https://doi.org/10.1016/j.jvs.2011.05.017
Eklof B, Albretique IJ, Einarsson E, Plate G. The temporary arteriovenous fistula in venous reconstructive surgery. Int Angiol. 1985;4:455-462.
Gombert A, Barbati ME, Grommes J, Kurstjens RL, deWolf MA, Wittens CH, Jalaie H. Wound complications after common femoral vein endophlebectomy: Influence on outcome. Phlebology. 2018;33(6):407-417. https://doi.org/10.1177/0268355517714712
Puggioni A, Kistner RL, Eklof Bo, Lurie F. Surgical disobliteration of postthrombotic deep veins — endophlebectomy — is feasible. J Vasc Surg. 2004;39(5):1048-1052. https://doi.org/10.1016/j.jvs.2003.12.036
Gombert A, Barbati ME, Grommes J, Kurstjens RL, deWolf MA, Wittens CH, Jalaie H. Wound complications after common femoral vein endophlebectomy: Influence on outcome. Phlebology. 2018;33(6):407-417. https://doi.org/10.1177/0268355517714712
Garg N, Gloviczki P, Karimi KM, Duncan AA, Bjarnason H, Kalra M, Oderich GS, Bower TC. Factors affecting outcome of open and hybrid reconstructions for nonmalignant obstruction of iliofemoral veins and inferior vena cava. J Vasc Surg. 2011;53(2):383-393. https://doi.org/10.1016/j.jvs.2010.08.086
Nicolaides A, Kakkos S, Eklof B, Perrin M, Nelzen O, Neglen P, Partsch H, Rybak Z. management of chronic venous disorders of the lower extremity. Guidelines according to scientific evidence. Int Angiol. 2014;33(2):173-175.
Raju S, Darcey R, Neglén P. Unexpected major role for venous stenting in deep reflux disease. J Vasc Surg. 2010;51(2):401-408. https://doi.org/10.1016/j.jvs.2009.08.032