To the content
2 . 2022

Surgical thrombectomy for treatment of acute iliofemoral venous thrombosis

Abstract

Background. Deep vein thrombosis of the lower extremities is one of the most common vascular diseases, which is accompanied by the development of such severe complications as pulmonary embolism and post-thrombotic syndrome.

Aim – to assess the effectiveness of open surgical thrombectomy in acute iliofemoral venous thrombosis.

Material and methods. The prospective cohort study included 65 patients, who underwent transfemoral venous thrombectomy (VT) in acute iliofemoral venous thrombosis. 10 patients received  a venous hybrid operation comprising balloon-catheter thrombectomy and stenting of residual stenosis of iliac vein. The control group consisted of 44 patients who received standard anticoagulant therapy. The results were evaluated by duplex ultrasound. The assessment of clinical effectiveness was made with Venous Clinical Severity Score, Villalta Score and Chronic Venous Insufficiency Questionnaire.

Results. Secondary patency of iliofemoral segment at 6 months of monitoring after thrombectomy was reported in 97% of cases. Meanwhile, the recanalization of iliofemoral segment was registered only in 27% (p<0.0001) of patients who had anticoagulant therapy alone. The median preoperative VCSS was 7, which dropped to 2 at 6 months (p=0.002). There were 5 cases of successful re-thrombectomy and stenting (3 cases). Сumulative primary and secondary patency rates  of iliofemoral veins at 72 months were 88 and 95%, respectively. The data Villalta score in long-term follow-up in patients after surgery was significantly lower than in patients treated with anticoagulation (p<0.001). Quality of life of patients of patients after 6 years of VT was improved, its mean score decreased from 45.3 (8.6) to 23.6 (6.1); p<0.001.

Conclusion. According to selective indications open surgical thrombectomy in iliofemoral venous thrombosis with using current methods of deep vein restoration patency increases the effectiveness of treatment of this severe pathology and prevents from progression of postthrombotic syndrome.

Keywords:acute iliofemoral venous thrombosis; open surgical thrombectomy; stenting; post-thrombotic syndrome; duplex ultrasound examination

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Ignatyev I.M., Evseeva V.V., Gradusov E.G. Surgical thrombectomy for treatment of acute iliofemoral venous thrombosis. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (2): 60–9. DOI: https://doi.org/10.33029/2308-1198-2022-10-2-60-69 (in Russian)

References

1.      Coiteux I., Mazzolai L. Deep venous thrombosis: epidemiology, risk factors and natural history // Schweiz. Rundsch. Med. Prax. 2006. Vol. 95. P. 455–459. DOI: https://doi.org/10.1024/0369-8394.95.12.455   

2.      Hölper P., Kotelis D., Attigah N., Hyhlik-Dürr A., Böckler D. Long-term results after surgical thrombectomy and simultaneous stenting for symptomatic iliofemoral venous thrombosis // Eur. J. Vasc. Endovasc. Surg. 2010. Vol. 39. P. 349-355. DOI: https://doi.org/10.1016/j.ejvs.2009.09.028  

3.      Anderson F.A. Jr, Wheeler H.B., Goldberg R.J., Hosmer D.W., Patwardhan N.A., Jovanovic B. et al. A population-based perspective of the of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism // Arch. Intern. Med. 1991. Vol. 151. P. 933–938. DOI: https://doi.org/10.1001/archinte.1991.00400050081016   

4.      Mewissen M.W., Seabrook G.R., Meissner M.H., Cynamon J., Labropoulos N., Haughton S.H. Catheter directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry // Radiology. 1999. Vol. 2. P. 39–49. DOI: https://doi.org/10.1148/radiology.211.1.r99ap4739  

5.      Colledge-Smith P.D. The aethiology and pathophysiology of chronic venous insufficiency and leg ulcers // Recent Advances in Surgery / eds C.D. Johnson, I. Taylor. Edinburg : Churchill Livingstone, 2000. P. 125-140.

6.      Johnson B.F., Manzo R.A., Bergelin R.O., Strandness D.E. Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one-to-six year follow-up // J. Vasc. Surg. 1995. Vol. 21. P. 307–312. DOI: https://doi.org/10.1016/s0741-5214(95)70271-7  

7.      Akesson H., Brudin L., Dahlström J.A., Eklöf B., Ohlin P., Plate G. Venous function assessed during 5-year period ilio-femoral venous thrombosis treated with anticoagulation // Eur. J. Vasc. Surg. 1990. Vol. 4. P. 43-48.

8.      Schwarzbach M.H., Schumacher H., Böckler D., Fürstenberger S., Thomas F., Seelos R. et al. Surgical thrombectomy followed by intraoperative endovascular reconstruction for symptomatic ilio-femoral venous thrombosis // Eur. J. Vasc. Endovasc. Surg. 2005. Vol. 29. P. 56-66. DOI: https://doi.org/10.1016.j.ejvs.2004.09.022  

9.      Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО) // Флебология. 2015. № 4. С. 8–22.

10.   Haig Y., Enden T., Grotta O., Klow N.T., Slagsvold C.E., Ghamina V.V. et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomized controlled trial //  Lancet Haematol. 2016. Vol. 3. P. 64–71. DOI: https://doi.org/101016/S2352-3026(15)00248-3  

11.   Vedantham S., Goldhaber S.Z., Julian J.A., Kahn S.R., Jaff M.R., Cohen D.J. et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis // N. Engl. J. Med. 2017. Vol. 377. P. 2240–2252. DOI: https://doi.org/10.1056/NEJMoa1615066  

12.   Meissner M.H. Rationale and indications for aggressive early thrombus removal // Phlebology. 2012. Vol. 27, suppl. 1.  P. 78–84. DOI: https://doi.org/10.1258/phleb.2012.012S11  

13.   Casey E.T., Murad M.H., Zumaeta-Garcia M., Elamin M.B.,  Shi Q., Erwin P.J. et al. Treatment of acute iliofemoral deep vein thrombosis // J. Vasc. Surg. 2012. Vol. 55. P. 1463–1473. DOI: https://doi.org/10.1016./j.jvs.201112.082  

14.   Kahn S.R. Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome // J. Thromb. Haemost. 2009. Vol. 7. P. 884–888. DOI: https://doi.org/10.1111/j.1538-7836.2009.03339.x  

15.   Launois R., Reboul-Marty J., Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ) // Qual. Life Res. 1996. Vol. 5.  P. 539–554.

16.   Pokrovsky A., Ignatyev I., Gradusov E. First experience of performing hybrid operations in chronic venous obstructions of iliofemoral segments in patients with postthrombotic syndrome // Vasc. Endovasc. Surg. 2017. Vol. 5. P. 447–452. DOI: https://doi.org/10.1177/15385574417717609  

17.   Meissner M.H., Gloviczki P., Comerota A.J., Dalcing M.C., Eklöf B.J., Gillespie D.L. et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous  Forum // J. Vasc. Surg. 2012. Vol. 55. P. 1449-1462. DOI: https://doi.org/10.1016/j.jvs.2011.12.081  

18.   Nicolaides A.N., Fareed J., Kakkar A.K., Comerota A.J., Goldhaber S.Z., Hull R. et al. Prevention and treatment of venous thromboembolism. International Consensus Statement // Int. Angiol. 2013. Vol. 32. P. 225. DOI: https://doi.org/10.1016/0268-9499(90)90219-a  

19.   Plate G., Einarsson E., Ohlin P., Jensen R., Qvarfordt P., Eklöf B. Thrombectomy with temporary arteriovenous fistula: the treatment of choice in acute iliofemoral venous thrombosis // J. Vasc. Surg. 1984. Vol. 1. P. 867-876. DOI https://doi.org/10.1067/mva.1984.avs0010867  

20.   Neglén P., al-Hassan H.K., Endrys J., Nazzal M.M., Christenson J.T., Eklöf B. Iliofemoral venous thrombectomy followed by percutaneous closure of the temporary arteriovenous fistula // Surgery. 1991. Vol. 110. P. 493-499.

21.   Hartung O., Benmiloud F., Barthelemy P., Dubuc M.,  Boufi M., Alimi Y.S. Late results of surgical venous thrombectomy with iliocaval stenting // J. Vasc. Surg. 2008. Vol. 47. P. 381–387. DOI: https://doi.org/10.1016/j.jvs.2007.10.007  

22.   Juhan C.M., Alimi Y.S., Barthelemy P.J., Fabre D.F.,  Riviere C.S. Late results of iliofemoral venous thrombectomy // J. Vasc. Surg. 1997. Vol. 25. P. 417–422. DOI: https://doi.org/10.1016/s0741-5214(97)70249-0  

23.   Kearon C., Kahn S.R., Agnelli G., Goldhaber S., Raskob G.E., Comerota A.J. Antithrombotic therapy for venous thromboembolic disease: ACCP evidence-based clinical practice guidelines (8th ed.) // Chest. 2008. Vol. 133. P. 454S–545S. DOI: https://doi.org/10.1378/chest.08-0658  

24.   Lindow C., Mumme A., Asciutto G., Strohmann B., Hummel T., Geier B. Long-term results after transfemoral venous thrombectomy for iliofemoral deep venous thrombosis // Eur. J. Vasc. Endovasc. Surg. 2010. Vol. 40. P. 134–138. DOI: https://doi.org/10.1016/j.ejvs.2010.02.023  

25.   Masuda E.M. Open venous thrombectomy: a technique that is still necessary in some patients. VEITHsymposium On-Demand 2016 Catalog. [Electronic resource]. URL: http//www.veithondemand.com/2016/login.php  

26.   Vedantham S., Thorpe P.E., Cardella J.F., Grassi C.J., Patel N.H., Ferral H. et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal // J. Vasc. Interv. Radiol. 2006. Vol. 17. P. 435–437. DOI: https://doi.org/10.1097/01.RVI.0000197348.57762.15  

27.   Wagenhäuser M.U., Sadat H., Dueppers P., Meyer-Janiszewski Y.K., Spin J.M., Schelzig H., Duran M. Open surgery for iliofemoral deep vein thrombosis with temporary arteriovenous fistula remains valuable // Phlebology. 2018. Vol. 33. P. 600-609. DOI: https://doi.org/10.1177/0268355517736437  

28.   Comerota A.J. The future of deep venous thrombosis and post-thrombotic syndrome in 2020 // Phlebology. 2012. Vol. 27, suppl. 1. P. 95–102. DOI: https://doi.org/10.1258/phleb.2011.012s08

CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Вскрытие
Medicine today

Уважаемые коллеги! Представляем оргкомитет 17-го Национального конгресса терапевтов (с международным участием) , который состоится 12-14 октября в МВЦ "Крокус Экспо" (павильон 3, Зал 20, г. Москва). · Президент Российского научного медицинского общества терапевтов,...

IV Съезд онкологов Московской области 7 октября 2022 года Активное развитие онкологической службы позволяет эффективно решать проблемы, возникающие на всех уровнях оказания помощи пациентам с онкозаболеваниями. Одним из успешных примеров такого взаимодействия является IV...

II Всероссийская конференция с международным участием "Воспаление глаза" 12 ноября 2022 года, Москва Воспалительные заболевания глаза - широко распространенная и многогранная проблема, с которой может столкнуться в своей практике любой специалист. Найти оптимальные алгоритмы...


Journals of «GEOTAR-Media»