Endovascular Management for Chronic Obstructive Iliofemoral Deep Vein Thrombosis, Mid-Term Result

Chiu-Yang Lee

Department of Surgery, Taipei Veterans General Hospital, Taiwan
Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Taiwan

^*Correspondance to: Chiu-Yang Lee 

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Abstract:

Background: The purpose of this study was to assess the result of endovascular intervention including angioplasty alone (control group) or angioplasty plus stenting (stent group) in treating chronic obstructive iliofemoral Deep Vein Thrombosis (DVT).
Methods: All the patients treated with endovascular interventions between January 2009 and October 2014 were examined for primary patency, assisted patency, and midterm venous functional outcomes.
Results: The overall success rate of endovascular technique was 88.9% (71 of 82 patients).No mortality, but minimal complications like ecchymosis and hematoma at puncture sites were found. 36-month primary patency rate and 36-month assisted patency rate were 63.9% and 72.2% of the stent group, and 17.6% and 26.4% of the control group, respectively. The survival analysis of the Kaplan-Meier curves and life table indicating the cumulative primary and assisted patency rate after 36 months in both angioplasty and stent groups are presented in Figure 1A (Log-rank test, P<0.001) and B (Log-rank test, P<0.001). Femoral valvular incompetence was observed in 58.3% and 82.4% of stent and control patients (P=0.028). The median (IQR) Villalta scores after 36 months, were 5.5 (3.3 to 7.0) and 7 (5 to 8) in stent and control patients (P=0.022), respectively. Post-Thrombotic Syndrome (PTS) were found in 50% and 79.4% of stent and control groups (P=0.01), respectively. Bleeding events during therapy were found in 27.8% and 17.6% of stent and control patients (P=0.313), respectively. Recurrent DVT was found in 19.4% and 52.9% of stent and control patients (P=0.003) at twenty-four follow-up. Using a univariate and multivariate Cox regression, recurrent DVT, DVT duration and treatment method were principal predicting factors of the 24-month primary patency (Duration of DVT, HR=5.13, 95% CI: 1.68 to 15.7, P=0.004; Recurrent DVT, HR=0.35, 95% CI: 0.17 to 0.72, P=0.004; Treatment method, HR=0.5, 95% CI: 0.26 to 0.96, P=0.036) after adjustment of gender and age and BMI.
Conclusion: This study suggests treatment method, DVT duration and recurrent DVT may be primary factors influencing vein patency. Endovascular intervention with stenting should be considered early for obstructive iliofemoral DVT because of a high technical success rate and acceptable mid-term, functional outcomes. A larger and randomized trial needs to be conducted in the future.

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Cite the Article:

Lee C-Y. Endovascular Management for Chronic Obstructive Iliofemoral Deep Vein Thrombosis, Mid-Term Result. World J Surg Surgical Res. 2019; 2: 1099.