The application of systematic approach in the treatment of acute lower extremity deep venous thrombosis combined with iliac venous compression syndrome

Abstract

Objective To evaluate the efficacy and safety of systematic approach, which consists of inferior vena cava filter implantation, Angiojet percutaneous mechanical thrombectomy (PMT), iliac vein angioplasty in one-stage, catheter-directed thrombolysis(CDT) if necessary and filter retrieved finally, in the treatment of acute lower extremity deep venous thrombosis(DVT) combined with iliac venous compression syndrome (IVCS). Methods The clinical data of 35 cases with a diagnosis of acute left lower extremity DVT combined with IVCS treated through systematic approach from May 2016 to October 2017 were retrospectively reviewed. The patency rate of iliac vein stent, venous clinical severity score (VCSS) and Villalta score one year post-operation were recorded. Results The technical success rate was 100% (35/35). Iliofemoral venous thrombus clearance rate of grade Ⅲ was obtained in 21 cases while 14 in grade Ⅱ after PMT. All cases underwent iliac vein angioplasty in one-stage, of which 14 cases with grade Ⅱ iliofemoral venous thrombus clearance rate were reached grade Ⅲ after CDT. Inferior vena cava filter implantation and retrieval was performed in all of the 35 cases with no complication such as symptomatic pulmonary embolism (PE) or severe hemorrhage. The mean time of hospitalization was (6.74±0.74) days. After one year follow-up, stent thrombosis were found in two cases, with the primary patency rate of 94.29% (33/35). Meanwhile, the VCSS score was improved significantly (0.66±1.75 vs 8.66±0.59, P<0.05). The rate of non-PTS (Villalta score 0~4) was 91.43% (32/35) while mild-PTS (Villalta score 5~9) rate was 8.57% (3/35), and the average Villalta score was 1.11±1.98. Conclusions The systematic approach, which optimizes the endovascular treatment process, is safe and efficient in the treatment of acute lower extremity DVT combined with IVCS. Key words: Systematic approach; Endovascular treatment; Acute lower extremity deep venous thrombosis; Iliac vein compression syndrome