Endovascular therapy for chronic, central type, deep vein thrombosis

Abstract

Our aim was to explore the feasibility and effectiveness of endovascular therapy for chronic, central type, deep vein thrombosis (DVT). A total of 46 iliac vein thrombotic patients with a history of 3 months to 12 years received endovascular therapy. There were 38 cases involving the left lower limb and eight the right lower limb. The average circumference of the affected lower extremities, which was taken 10 cm above the knee before surgery, was 8.9±6.4 cm longer than the corresponding unaffected limb. One to three self-expanding stents with a diameter of 12 or 14 mm were deployed in each thrombotic iliac vein through incision of the femoral vein under supervision of digital subtraction angiography with general or epidural anaesthesia. Strict anticoagulation with an internationalized normalised ratio between 2–3 and an elastic support with elastic stockings were then used life long. Three cases failed because of the inability to pass through a wire or catheter. Forty-three cases were successful (93.5%). An average of 2.2 stents were deployed in each occluded iliac vein. Complete venography demonstrated immediate reactivation of the occluded iliac veins with an obvious decrease in compensational collateral venous branches. The average difference in the circumference of the thigh dropped to 2.6±1.7 cm within 3 days postoperatively. A follow-up of 2–36 months showed eight patients suffering from re-occlusion because of a pause or interruption in the anticoagulation therapy. The remaining 35 cases remained patent. Endovascular therapy is a choice for chronic, central type DVT, and postoperative anticoagulation and compression therapy are of great importance for patency. The mid- and long-term results must still be determined.