Arteriovenous fistula geometry in hybrid recanalisation of post-thrombotic venous obstruction.
BACKGROUND
Post-thrombotic obstruction can be adequately treated by percutaneous transluminal angioplasty and stenting. When post-thrombotic trabeculations extend below the femoral confluence, proper inflow can be facilitated by endophlebectomy and creation of an arteriovenous fistula. The aim of this study was to investigate whether it is more favourable to place the arteriovenous fistula at the cranial or caudal end of the endophlebectomy to prevent stenosis or occlusion.


METHODS
We retrospectively analysed the clinical data of all patients who underwent a hybrid procedure in our two centres. Demographics, interventional details and post-operative imaging were collected.


RESULTS
Data on 42 limbs with cranially and 23 limbs with caudally placed arteriovenous fistulas were collected. Post-thrombotic disease of the profunda femoral vein alone or in combination with the femoral vein was observed more often in the cranial group. The caudal group more often received a smaller sized and straight polytetrafluoroethylene fistula, while the cranial group comprised a significantly higher amount of stented segments. Logistic regression showed that only reduced femoral inflow (hazard ratio 2.934 (95%CI, 1.148-7.494)) was a significant predictor of stent stenosis and/or occlusion. Logistic regression for risk of occlusion showed a significant influence of stent-related complications (hazard ratio 4.691 (95%CI, 1.205-18.260)) and a tendency towards influence of arteriovenous fistula geometry in favour of the cranially placed fistula.


CONCLUSIONS
Placement of the arteriovenous fistula in the cranial part of the endophlebectomy during hybrid recanalisation may result in a more favourable outcome, yet this tendency was not statistically significant. Moreover, femoral inflow is pivotal in maintaining patency and should thus be adequately assessed pre-operatively.
Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands r.kurstjens@maastrichtuniversity.nl.
R L M
RL
Kurstjens
Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
R
R
de Graaf
Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany.
M E
ME
Barbati
Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.
M A F
MA
de Wolf
Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
J H H
JH
van Laanen
Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany.
C H A
CH
Wittens
Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany.
H
H
Jalaie
D000328:Adult; D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054070:Postthrombotic Syndrome / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies
Arteriovenous fistula; deep venous obstruction; endophlebectomy; endovenectomy; occlusion; post-thrombotic syndrome; stent