Surgical thrombectomy followed by intraoperative endovascular reconstruction for symptomatic ilio-femoral venous thrombosis.
OBJECTIVE
To evaluate the efficacy of surgical thrombectomy combined with endovascular reconstruction for acute ilio-femoral/caval venous thrombosis.


METHODS
Twenty consecutive patients with acute, symptomatic ilio-femoral/-caval thrombosis underwent valve-preserving thrombectomy with immediate endovascular repair between October 1996 and October 2003. Thrombectomy was classified by intraoperative venography as: TYPE I=complete, TYPE II=partial, TYPE III=complete with stenosis other than thrombus, TYPE IV=permanent occlusion. TYPEs I and IV were excluded from this analysis because endovascular repair was not performed.


RESULTS
Left-sided venous thrombosis predominated (90%). Lesions were located in the common iliac vein (85%), the external iliac vein (10%), and the inferior vena cava (5%). Three TYPE II lesions and 17 TYPE III lesions (11 spurs, one hypoplasia, one fibrosis, one haematoma, and three others) were diagnosed. Catheter-directed recanalisation (thrombectomy/thrombolysis) resolved TYPE II lesions in three patients. Balloon angioplasty (one patient), iliac stenting (15 patients [two with thrombolysis]), and caval stenting (one patient) were employed in TYPE III stenoses. No serious complication or death occurred. Mean follow-up was 21 months. Of 20 patients clinical results were excellent in 18 patients who maintained patency of their reconstructed iliac veins. Primary and secondary patency rates were 80 and 90%, respectively.


CONCLUSIONS
Ilio-caval venous obstructions detected intraoperatively can be reconstructed in a one-stage combined procedure. The specific endovascular approach depends on the type of residual venous obstruction. Excellent mid-term results indicate that the proposed thrombectomy classification (TYPE I-IV) and treatment algorithm optimises the results in selected patients with symptomatic venous thrombosis.
Schwarzbach
M H M
MH
Department of Vascular and Endovascular Surgery, University of Heidelberg, D-69120 Heidelberg, Germany. matthias.schwarzbach@med.uni-heidelberg.de
Schumacher
H
H
Böckler
D
D
Fürstenberger
S
S
Thomas
F
F
Seelos
R
R
Richter
G M
GM
Allenberg
J-R
JR
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D017130:Angioplasty / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000601:surgery*