Treatment Of Iliofemoral Vein Thrombosis Research Articles

Endovascular Treatment for Iliofemoral Vein Thrombosis with Composite Stents

To evaluate the applicability of endovascular treatment for iliofemoral vein thrombosis with composite stents. Between September 2013 and August 2016, 29 consecutive patients underwent endovascular therapy with composite stents for iliofemoral vein thrombosis and were followed up at our institution. All the patients with acute or chronic iliofemoral vein thrombosis enrolled in this study were evaluated by color Doppler ultrasonography and diagnosed by venography. Treatment measures and related complications were recorded, and cumulative stent patency was assessed with Kaplan-Meier curves. Patients with acute iliofemoral vein thrombosis (n=7) were successfully treated with catheter-directed thrombolysis treatment, balloon angioplasty, and stents, whereas patients (n==22) with chronic deep vein thrombosis were treated successfully by balloon angioplasty and stent only. Among all patients, 2 stents were inserted in 25 patients, whereas 3 stents were deployed in 4 patients. Endovascular treatment for iliofemoral vein thrombosis with laser-cut stents combined with Wallstents showed primary patency of treated limbs at 6, 12, and 24months was 96.6%, 93.1% and 93.1%, respectively. Mean duration of follow-up was 23months, and there was no occurrence of contralateral vein thrombosis during follow-up by ultrasound. Iliofemoral vein thrombosis was successfully recanalized by endovascular therapy with composite stents, and there was no occurrence of contralateral vein thrombosis by ultrasound during follow-up.

Combined Regional Thrombolysis and Surgical Thrombectomy for Treatment of Iliofemoral Vein Thrombosis

Combined Regional Thrombolysis and Surgical Thrombectomy for Treatment of Iliofemoral Vein Thrombosis

Combined regional thrombolysis and surgical thrombectomy for treatment of iliofemoral vein thrombosis

In at least half of patients with iliofemoral deep vein thrombosis post-thrombotic syndrome develops when only anticoagulant therapy is given. We combined thrombolysis, applied under ischemic conditions,with surgical thrombectomy to restore patency and valve function. The technique and the short-term and long-term results in 2 patient series are reported. A catheter was inserted into a foot vein of the thrombosed leg, and the limb was excluded from the circulation with a pneumatic cuff placed on the thigh with the patient under general anesthesia. Urokinase (0.5 million-3 million IU) and heparin were infused and allowed to act for 30 minutes while the pelvic axis was cleared with a Fogarty catheter through an inguinal venotomy. The external iliac vein was then clamped and the cuff removed. Thrombi that detached from the wall were flushed out with reactive hyperemia and squeezed out with manual leg compression. The blood was retrieved, washed, and transfused back into the patient. Various additional procedures were performed to secure outflow. Two patient series are reported: 1 with 12 consecutive patients and 1 with 21 patients who were successfully treated 6 to 10 years previously. Follow-up data were obtained for all patients after 1 year and for 18 of 21 patients after 6 to 10 years. Patency and valve function were assessed with duplex scanning or venography. Studies of blood coagulation and the kinetics of urokinase were performed in 5 additional patients. Vein patency and valve function were restored in all consecutive patients. At 1 year none of the 33 patients had had recurrence, and none showed clinical signs of post-thrombotic syndrome. At 6 to 10 years 3 of 18 patients had experienced another venous thromboembolism, but none in the treated leg. Sixteen legs were asymptomatic without compression therapy, and 2 had venous claudication. Coagulation studies showed a trace concentration of urokinase and a mild decrease in fibrinogen in the systemic circulation. The concentration of urokinase in blood collected from the treated leg was only 1% of that infused. Regional thrombolysis combined with surgical thrombectomy is relatively easy to perform and seems safe. Vein patency and valve function were restored, and post-thrombotic syndrome was prevented. Additional procedures to overcome pelvic vein obstructions were required in 11 of 33 patients (33%). The procedure should be tested against standard anticoagulation therapy in patients with acute iliofemoral thrombosis.

Surgical Treatment of Iliofemoral Vein Thrombosis in Pregnancy

The incidence of deep leg vein thrombosis in pregnancy is estimated at 0.13 per 1000 to 1.4 per 100.1−3 One-third occur as isolated, descending iliofemoral vein thromboses, predominantly left-sided. We report our surgical experiences in venous thrombectomy with arteriovenous fistula (AV-fistula) in the groin between the superficial femoral artery and femoral vein in 29 gravidae with a mean age of 27.5 years (range 19–41 years). Thrombosis occurred between the 20th and 36th week of pregnancy. 25 were antepartum two postpartum and two postsectionem. An iliac spur was seen once, as was an AT III deficiency. At the beginning of our series AV-fistula was not performed in three patients who all suffered from re-thrombosis after 24 h. Re-thrombectomy with an AV-fistula was performed successfully. Three of the 26 gravidae with AV-fistula also developed re-thrombosis. In two patients re-thrombectomy was successful, in the third patient the common iliac vein could not be re-opened by thrombectomy and the functioning AF-fistula had been ligated because extensive vulval oedema had developed. Asymptomatic, late re-thrombosis occurred in two patients who were seen at outpatient follow-up. We have seen one mild, non-life-threatening pulmonary embolism on the first postoperative day. No further intraoperative nor postoperative or postpartum complications developed. The re-occlusion rate is 10.3% (3/29), the complication rate is 6.9% (2/29).