Long-term results of venous thrombectomy combined with a temporary arterio-venous fistula.
Forty-one patients with acute iliofemoral venous thrombosis were randomised to conventional anticoagulation or acute thrombectomy combined with a temporary arterio-venous fistula (AVF) and anti-coagulation. Follow-up after 5 years in 22 medical and 19 surgical patients revealed slightly more asymptomatic patients (37 vs. 18%) and less frequent severe post-thrombotic sequelae (16 vs. 27%) in the surgical group (N.S.). The iliac vein was more frequently (P less than 0.05) normal following thrombectomy (71 vs. 30%) as demonstrated by radionuclide angiography, but occlusion plethysmography showed an outflow capacity (61 vs. 45 ml/min/100 ml) that was not significantly better. There was no obvious difference in muscle pump function (EVrel) and reflux (Q/EVrel) assessed by foot volumetry. Still, the ambulatory venous pressure was significantly (P less than 0.05) lower in the surgical group. There was a tendency towards better results following thrombectomy in patients with fresh thrombosis and a successful initial procedure. Although the numbers of observations in many cases were too small to provide statistical evidence of benefit with venous thrombectomy + AVF, this procedure seems to improve the long-term outcome following acute iliofemoral venous thrombosis. Since the difference in outcome is not very striking, anticoagulation treatment is still an acceptable alternative.
Plate
G
G
Department of Surgery, Central Hospital, Helsingborg, Sweden.
Akesson
H
H
Einarsson
E
E
Ohlin
P
P
Eklöf
B
B
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011875:Radionuclide Angiography; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000601:surgery; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*
D000925:Anticoagulants