ENDOVENOUS MANAGEMENT OF CHRONIC VENOUS INSUFFICIENCY

  • Thomas C. Hall Department of Interventional Radiology. QMC, Nottingham, NG7 2UH
  • Bruce D. Braithwaite Department of Vascular Surgery. QMC, Nottingham, NG7 2UH
  • Richard O'neill Department of Interventional Radiology. QMC, Nottingham, NG7 2UH
  • Said Habib Department of Interventional Radiology. QMC, Nottingham, NG7 2UH
Keywords: Angioplasty, Deep vein thrombosis, Iliac vein compression syndrome, Stents, Venous insuficiency, Peripheral vascular disease

Abstract

Purpose: The e!cacy of endovenous stenting for ileofemoral stenosis or occlusion in post-thrombotic syndrome (PTS) is gaining momentum with studies reporting improved clinical outcome. This study analyses the outcomes of venous stenting in PTS for patients in whom conservative and/or prior surgical treatment modalities had failed.

Materials and Method: Operative and clinical records were retrospectively analysed in all patients who had endovenous stenting for PTS. Baseline demographics, procedural details and symptom severity based on CEAP and Villalta scores were collected. Stent patency was assessed by follow-up duplex ultrasound. Clinical follow-up included Villalta score and a subjective assessment of improvement.

Results: Fifteen patients with a mean Villalta score of 11 were treated. Two were lost to follow-up. Technical success was 100% with no major complication. Two minor complications (self-limiting bleeding) occurred. At follow-up, stent patency, by Duplex ultrasound, was 71.4% at 13 (range 5–54) weeks. 53.8% (n=7) of patients reported subjective improvement in their symptoms, 30.8% (n=4) of patients reporting no improvement and 15.4% (n=2) of patients reporting worsening of their symptoms. The mean Villalta score at follow-up was 8.5; a signi"cant reduction (p=0.049) from the pre-procedural score.

Conclusion: Endovenous stenting for PTS can be performed safely and with a high technical success rate. Patency rates are reasonable and are associated with a signi"cant reduction in Villalta scores.

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References

1. Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125(1):1-7.

2. Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149(10):698-707.

3. Prandoni P, Kahn SR. Post-thrombotic syndrome: Prevalence, prognostication and need for progress. Br J Haematol. 2009;145(3):286-295.

4. Guanella R, Ducruet T, Johri M, et al. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: A prospective evaluation. J Thromb Haemost. 2011;9(12):2397-2405.

5. Kahn SR, Shbaklo H, Lamping DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost. 2008;6(7):1105-1112.

6. Kahn SR, Ducruet T, Lamping DL, et al. Prospective evaluation of health-related quality of life in patients with deep venous thrombosis. Arch Intern Med. 2005;165(10):1173-1178.

7. Araki CT, Back TL, Padberg FT, et al. The signi"cance of calf muscle pump function in venous ulceration. J Vasc Surg. 1994;20(6):872-7; discussion 878-9.

8. Nicolaides AN, Hussein MK, Szendro G, Christopoulos D, Vasdekis S, Clarke H. The relation of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg. 1993;17(2):414-419.

9. Douketis JD, Crowther MA, Foster GA, Ginsberg JS. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis? Am J Med. 2001;110(7):515-519.

10. Wille-Jorgensen P, Jorgensen LN, Crawford M. Asymptomatic postoperative deep vein thrombosis and the development of postthrombotic syndrome. A systematic review and meta-analysis. Thromb Haemost. 2005;93(2):236-241.

11. O'Donnell MJ, McRae S, Kahn SR, et al. Evaluation of a venous-return assist device to treat severe post-thrombotic syndrome (VENOPTS). A randomized controlled trial. Thromb Haemost. 2008;99(3):623-629.

12. Ginsberg JS, Magier D, Mackinnon B, Gent M, Hirsh J. Intermittent compression units for severe post-phlebitic syndrome: A randomized crossover study. CMAJ. 1999;160(9):1303-1306.

13. Jost CJ, Gloviczki P, Cherry KJ,Jr, et al. Surgical reconstruction of iliofemoral veins and the inferior vena cava for nonmalignant occlusive disease. J Vasc Surg. 2001;33(2):320-7; discussion 327-8.

14. Razavi MK, Ja# MR, Miller LE. Safety and e#ectiveness of stent placement for iliofemoral venous out$ow obstruction: Systematic review and meta-analysis. Circ Cardiovasc Interv. 2015;8(10):e002772.

15. Seager MJ, Busuttil A, Dharmarajah B, Davies AH. Editor's choice - A systematic review of endovenous stenting in chronic venous disease secondary to iliac vein obstruction. Eur J Vasc Endovasc Surg. 2016;51(1):100-120.

16. Sarici IS, Yanar F, Agcaoglu O, et al. Our early experience with iliofemoral vein stenting in patients with post-thrombotic syndrome. Phlebology. 2014;29(5):298-303.

17. Raju S, Kirk OK, Jones TL. Endovenous management of venous leg ulcers. J Vasc Surg Venous Lymphat Disord. 2013;1(2):165-172.

18. Gwozdz A, Saha P, Silickas J, et al. Early duplex surveillance following deep venous stenting for the treatment of post-thrombotic
syndrome can predict patients at greatest risk for re-intervention BSET Annual Meeting 2018. 2018.

19. Black S, Gwozdz A, Karunanithy N, et al. Two year outcome after chronic iliac vein occlusion recanalisation using the vici venous stent((R)). Eur J Vasc Endovasc Surg. 2018.

20. Neglen P, Tackett TP,Jr, Raju S. Venous stenting across the inguinal ligament. J Vasc Surg. 2008;48(5):1255-1261.

21. Gustafson A, Chick JFB, Malik RK, et al. VESS06. an intravascular ultrasound-based scoring system may predict future stent failure in the treatment of may-thurner syndrome. Journal of vascular surgery. 2018;67(6):e51.

22. Blanch Alerany M, Izquierdo Lamoca LM, Ramirez Ortega M, Lago Rivas I, Zotta Desboeufs R, Stefanov Kiuri S. Endovascular treatment of iliofemoral chronic post-thrombotic venous flow obstruction. J Vasc Surg Venous Lymphat Disord. 2014;2(1):2-7.

23. Raju S, Davis M. Anomalous features of iliac vein stenosis that affect diagnosis and treatment. J Vasc Surg Venous Lymphat Disord.
2014;2(3):260-267.
Published
2020-02-05
Section
Original Article