Open thrombectomy in acute iliofemoral venous thrombosis

Pokrovsky A.V.^1,2, Ignatyev I.M.^3,4, Gradusov E.G.², Bredikhin R.A.^3,4

1) Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health,
2) Russian Medical Academy of Continuous Professional Education, under the RF Ministry of Public Health Moscow,
3) Interregional Clinical Diagnostic Centre,
4) Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia

Objective. The study was aimed at assessing efficacy of open thrombectomy in acute iliofemoral venous thrombosis.

Patients and methods. From January 2012 to December 2016, a total of 37 patients underwent transfemoral thrombectomy for acute iliofemoral venous thrombosis. The Control Group consisted of 24 patients receiving standard anticoagulant therapy. Six patients were subjected to a hybrid operation consisting in thrombectomy supplemented with stenting of the residual compression stenosis of the left common iliac vein (CIV).

The outcomes of the operations were controlled by means of duplex scanning. Clinical efficacy of the operations was evaluated with the help of the Venous Clinical Severity Score (VCSS) and CEAP classification.

Results. Patency of the iliofemoral segment at 6 months of follow up after thrombectomy was observed in 92% of patients. At the same time, in patients receiving anticoagulant therapy recanalization of the iliofemoral segment was observed in only 21% (5/24; χ²=31, p<0.01) of cases. Recanalization of the femoropopliteal segment 6 months after thrombectomy was noted to occur in 70% (23/33) of patients. The median of the composite index by the VCSS after 6 months decreased from 7 to 2 (p=0.002).

The cumulative patency of the iliofemoral segment 36 months after surgery amounted to 86%. Clinical assessment of the remote results of thrombectomy according to the CEAP classification demonstrated that 90% (19/21) of patients were either free from or had weakly pronounced symptoms of post-thrombotic syndrome.

Conclusion. Performing thrombectomy for iliofemoral thrombosis by selective indications using modern methods of restoring patency of deep veins significantly increases efficacy of treating patients presenting with this severe pathology and prevents the development of pronounced manifestations of post-thrombotic syndrome.

KEY WORDS: acute iliofemoral venous thrombosis, open thrombectomy, stenting, recanalization, ultrasonographic duplex scanning.

P. 184

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