Endophlebectomy of the common femoral vein and arteriovenous fistula creation as adjuncts to venous stenting for post-thrombotic syndrome

M A F de Wolf; H Jalaie; J H H van Laanen; R L M Kurstjens; M J S Mensinck; M J de Geus; A Gombert; R de Graaf; C H A Wittens

doi:10.1002/bjs.10461

journal article Feb 21, 2017

Endophlebectomy of the common femoral vein and arteriovenous fistula creation as adjuncts to venous stenting for post-thrombotic syndrome

M A F de Wolf H Jalaie J H H van Laanen R L M Kurstjens M J S Mensinck M J de Geus A Gombert R de Graaf C H A Wittens

British Journal of Surgery Vol. 104 No. 6 pp. 718-725 · Oxford University Press (OUP)

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Abstract

Abstract

Background
Good results have been reported for angioplasty and stenting of post-thrombotic lesions of the iliac and proximal femoral veins. If lesions at the origin of the superficial femoral and profunda veins are stented, the intraluminal synechiae can be pushed against the orifices of inflow vessels, potentially decreasing stent inflow. Surgical disobliteration of the common femoral vein (endophlebectomy) has been suggested to mitigate this problem. Because of a temporary increase in thrombogenicity, this procedure may be accompanied by arteriovenous fistula creation.

Methods
Data on consecutive patients treated by hybrid venous reconstruction, between December 2010 and May 2015, were analysed. Standard recording consisted of clinical scoring systems (including Villalta scale) and imaging. Patency was assessed with duplex ultrasonography.

Results
Seventy-six legs (70 patients) were included. Median follow-up was 379 (range 73–1508) days. Primary, assisted primary and secondary patency rates at 12 months were 51, 70 and 83 per cent respectively. Sixty per cent of loss of primary patency (24 of 40 legs) was related to common femoral vein stenosis, and the rest to rethrombosis. Other complications included wound infection (29 per cent) and lymphatic leak (39 per cent). The Villalta score had decreased by a median of 7 points at 1-year follow-up.

Conclusion
The combination of venous stenting, endophlebectomy and arteriovenous fistula creation for patients with extensive post-thrombotic vein damage and severe post-thrombotic syndrome is feasible.

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Metrics

38

Citations

21

References

Details

Published: Feb 21, 2017
Vol/Issue: 104(6)
Pages: 718-725
License: View

Authors

M

M A F de Wolf

Department of Surgery, Maastricht University Medical Centre , Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, The Netherlands

H

H Jalaie

Department of Vascular Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Nordrhein-Westfalen , Aachen, Germany

J

J H H van Laanen

Department of Surgery, Maastricht University Medical Centre , Maastricht, The Netherlands

R

R L M Kurstjens

Department of Surgery, Maastricht University Medical Centre , Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, The Netherlands

M

M J S Mensinck

Department of Surgery, Maastricht University Medical Centre , Maastricht, The Netherlands

M

M J de Geus

Department of Surgery, Maastricht University Medical Centre , Maastricht, The Netherlands

A

A Gombert

Department of Vascular Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Nordrhein-Westfalen , Aachen, Germany

R

R de Graaf

Department of Radiology, Maastricht University Medical Centre , Maastricht, The Netherlands

C

C H A Wittens

Department of Surgery, Maastricht University Medical Centre , Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, The Netherlands; Department of Vascular Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Nordrhein-Westfalen , Aachen, Germany

Funding

Medtronic

Olympus

Philips

Cite This Article

M A F de Wolf, H Jalaie, J H H van Laanen, et al. (2017). Endophlebectomy of the common femoral vein and arteriovenous fistula creation as adjuncts to venous stenting for post-thrombotic syndrome. British Journal of Surgery, 104(6), 718-725. https://doi.org/10.1002/bjs.10461

Endophlebectomy of the common femoral vein and arteriovenous fistula creation as adjuncts to venous stenting for post-thrombotic syndrome

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