Abstract
PurposeTo assess the technical success, patency, and clinical outcome, following assessment of inflow and infrainguinal endovenous stent placement in patients with iliofemoral post-thrombotic obstruction with infrainguinal involvement.MethodsA retrospective analysis of 39 patients with iliofemoral post-thrombotic venous obstruction accepted for infrainguinal stent placement in the period November 2009–December 2016. The clinical status was categorized according to the Clinical Etiological Anatomical Pathophysiological (CEAP) classification and symptom severity was assessed using Venous Clinical Severity Score (VCSS). The inflow was categorized as “good”, “fair”, or “poor” depending on vein caliber and extent of post-thrombotic changes in the inflow vessel(s). Stent patency was assessed by duplex ultrasound. Median follow-up was 44 months (range 2–90 months).ResultsStent placement was successful in all 39 patients. Primary patency after 24 months was 78%. Thirty of 39 patients (77%) had open stents at final follow-up. Re-interventions were performed in four patients and included catheter-directed thrombolysis (CDT) in all and adjunctive stenting in two. Twenty-eight of 39 patients (72%) reported a sustained clinical improvement. Patients with “good” inflow had better patency compared to those with “fair”/“poor” (p = 0.01). One patient experienced acute contralateral iliofemoral thrombosis; this segment was successfully treated with CDT and stenting. No other complications required intervention.ConclusionInfrainguinal endovenous stent placement was a feasible and safe treatment with good patency and clinical results, and should be considered in patients with substantial symptoms from post-thrombotic obstructions with infrainguinal involvement. Stents with good inflow have better patency and inflow assessment is essential in deciding the optimal stent landing zone.
Highlights
In chronic iliac vein obstructions percutaneous endovenous treatment with recanalization and stent placement, has shown to be effective for both post-thrombotic obstructions and non-thrombotic iliac vein lesions (Neglen et al, 2007; Hartung et al, 2009)
Following axial transformation the deep femoral vein may serve as an alternative inflow path for stenting and a potential stent landing zone (Raju et al, 1998; Raju 2007)
All 39 patients presented with chronic venous disease (CVD) symptoms of the lower limb
Summary
In chronic iliac vein obstructions percutaneous endovenous treatment with recanalization and stent placement, has shown to be effective for both post-thrombotic obstructions and non-thrombotic iliac vein lesions (Neglen et al, 2007; Hartung et al, 2009). The optimal endovenous stent placement is from one healthy vein segment to the obtaining adequate inflow and outflow (Neglen et al, 2008). In extensive post-thrombotic obstructions involving the infrainguinal veins, the optimal stent placement with regard to inflow is often challenged. In approximately 10–15% of patients with chronic venous femoropopliteal obstruction the deep femoral vein caliber and flow may increase over time, hereby transforming the deep femoral vein to a major outflow collateral. This transition of the deep femoral vein is termed axial transformation. Following axial transformation the deep femoral vein may serve as an alternative inflow path for stenting and a potential stent landing zone (Raju et al, 1998; Raju 2007)
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