Hybrid Procedure in Severe Postthrombotic Syndrome

Purpose: The common femoral vein (CFV) and iliac veins comprise the common channel for venous drainage of the lower extremities. Occlusive venous thrombosis of the CFV and iliac veins is associated with severe postthrombotic syndrome and in some cases with nonhealing vein ulcers. After percutaneous intervention, relative obstruction of the CFV can persist, leading to incomplete drainage of the femoral and profunda femoral veins system, thereby mitigating the benefit of iliac vein recanalization and risking rethrombosis and associated intrastent restenosis, resulting in a great challenge for endovascular management. With this paper, we aim to demonstrate the effectiveness of endovenectomy of the common femoral vein and venous stenting of the ileocavosegment in the treatment of patients with severe postthrombotic syndrome

Materials and Methods: We conducted a prospective study at a single center from January 2019 to June 2019, in patients with severe postthrombotic syndrome (Villaltas score >15 points), endovenectomy of the common femoral vein with bovine pericardium patch placement, and angioplasty with stenting in the iliocaval segment. Technical success was defined as the ability to achieve drainage of the deep femoral veins and a permeable channel in the ileofemoral segment toward the vena cava. Clinical the success was defined as decreased of Villaltas score less than 15 points in 1-month follow-up after procedure. Demographic data, comorbidities, procedural data, and follow-up information were recorded.

Results: Three limbs were treated three 3 patients with severe postthrombotic syndrome, one man and two women; the average age was 57 years (range, 52–61). Technical success was achieved in two patients; in one patient, it was not possible to achieve a drainage pathway to the iliocaval segment. However, clinical success was achieved in all patients.

Conclusions: The symptoms caused by venous obstruction of the ileofemoral segment greatly improve by restoring the drainage of deep femoral veins, common femoral vein, and iliac vein into the vena cava. Even by improving the drainage only of deep femoral veins, good clinical results are achieved.