T M A J van Vuuren1, M A F de Wolf2, C W K P Arnoldussen3, R L M Kurstjens2, J H H van Laanen4, H Jalaie5, R de Graaf6, C H A Wittens7. 1. Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: timme.van.vuuren@mumc.nl. 2. Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. 3. Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands; Department of Radiology, VieCuri Medical Centre, Venlo, The Netherlands. 4. Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. 5. Department of Vascular Surgery, University Hospital RWTH Aachen, Nordrhein-Westfalen, Pauwelsstraße 30, 52074, Aachen, Germany. 6. Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. 7. Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Vascular Surgery, University Hospital RWTH Aachen, Nordrhein-Westfalen, Pauwelsstraße 30, 52074, Aachen, Germany.
Abstract
OBJECTIVE/ BACKGROUND: Deep venous obstruction is relatively prevalent in patients with chronic venous disease. Endovascular treatments and hybrid interventions can be used to relieve venous outflow obstructions. This paper assesses mid-term clinical outcomes and patency rates in a large cohort after percutaneous and hybrid interventions. METHODS: This was a prospectively analysed cohort study. Patients with symptomatic deep venous obstruction who presented at a tertiary referral hospital were divided into three groups: patients who underwent percutaneous stenting for non-thrombotic iliac vein compression syndrome (IVCS group); patients with post-thrombotic syndrome (PTS) treated by percutaneous stent placement (P-PTS group); and PTS patients with obstruction involving the veins below the saphenofemoral junction in which a hybrid procedure was performed, combining stenting with open surgical disobliteration (H-PTS group). Patency rates, complications, and clinical outcomes were analysed. RESULTS: A total of 425 lower extremities in 369 patients were treated. At 60 months, primary patency, assisted primary patency, and secondary patency rates were 90%, 100%, and 100% for IVCS, and 64%, 81%, and 89% for the P-PTS group, respectively. The H-PTS group, showed patency rates of 37%, 62%, and 72%, respectively, at 36 months. Venous claudication subsided in 90%, 82%, and 83%, respectively. At the 24 month follow-up, mean Venous Clinical Severity Score decreased for all patients and improvement in Villalta score was seen in post-thrombotic patients. The number of complications was related to the extent of deep venous obstruction in which patients in the H-PTS group showed the highest complication rates (81%) and re-interventions (59%). CONCLUSION: Percutaneous stent placement to treat non-thrombotic iliac vein lesions, and post-thrombotic ilio-femoral obstructions are safe, effective, and showed patency rates comparable with previous research. Patients with advanced disease needing a hybrid procedure showed a lower patency rate and more complications. However, when successful, the clinical outcome was favourable at mid-term follow-up and the procedure may be offered to selected patients.
OBJECTIVE/ BACKGROUND:Deep venous obstruction is relatively prevalent in patients with chronic venous disease. Endovascular treatments and hybrid interventions can be used to relieve venous outflow obstructions. This paper assesses mid-term clinical outcomes and patency rates in a large cohort after percutaneous and hybrid interventions. METHODS: This was a prospectively analysed cohort study. Patients with symptomatic deep venous obstruction who presented at a tertiary referral hospital were divided into three groups: patients who underwent percutaneous stenting for non-thrombotic iliac vein compression syndrome (IVCS group); patients with post-thrombotic syndrome (PTS) treated by percutaneous stent placement (P-PTS group); and PTS patients with obstruction involving the veins below the saphenofemoral junction in which a hybrid procedure was performed, combining stenting with open surgical disobliteration (H-PTS group). Patency rates, complications, and clinical outcomes were analysed. RESULTS: A total of 425 lower extremities in 369 patients were treated. At 60 months, primary patency, assisted primary patency, and secondary patency rates were 90%, 100%, and 100% for IVCS, and 64%, 81%, and 89% for the P-PTS group, respectively. The H-PTS group, showed patency rates of 37%, 62%, and 72%, respectively, at 36 months. Venous claudication subsided in 90%, 82%, and 83%, respectively. At the 24 month follow-up, mean Venous Clinical Severity Score decreased for all patients and improvement in Villalta score was seen in post-thromboticpatients. The number of complications was related to the extent of deep venous obstruction in which patients in the H-PTS group showed the highest complication rates (81%) and re-interventions (59%). CONCLUSION: Percutaneous stent placement to treat non-thrombotic iliac vein lesions, and post-thrombotic ilio-femoral obstructions are safe, effective, and showed patency rates comparable with previous research. Patients with advanced disease needing a hybrid procedure showed a lower patency rate and more complications. However, when successful, the clinical outcome was favourable at mid-term follow-up and the procedure may be offered to selected patients.
Authors: Ole Grøtta; Tone Enden; Gunnar Sandbæk; Gard Filip Gjerdalen; Carl-Erik Slagsvold; Dag Bay; Nils-Einar Kløw; Antonio Rosales Journal: CVIR Endovasc Date: 2018-11-16
Authors: Pascale Notten; Jorinde H H van Laanen; Pieter Eijgenraam; Mark A F de Wolf; Ralph L M Kurstjens; Hugo Ten Cate; Arina J Ten Cate-Hoek Journal: Res Pract Thromb Haemost Date: 2020-04-08