First experience with hybrid operations for chronic obstruction of iliac-femoral segment veins in patients with post-thrombotic disease

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

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

The present study was aimed at assessing initial results of hybrid operations in obstructive lesions of the iliac-femoral veins in patients with post-thrombotic disease (PTD).

Hybrid operations [open endovenectomy from the common femoral vein (CFV) with creation of an arteriovenous fistula + stenting of iliac veins] were performed carried out in a total of eleven patients with PTD. Of these, there were 7 men and 4 women aged from 34 to 52 years (mean age – 42.8±7 years). All patients had severe-degree chronic venous insufficiency (CVI). The distribution of patients according to the CEAP classification was as follows: C4a – 2 patients, C4b – 4 patients, C5 – 4 subjects, C6 – 1 patient. The time having elapsed since a newly onset episode of acute iliac-femoral venous thrombosis varied from 2 to 12 years (averagely – 7.1±3.3 years). The degree of manifestation of PTD was determined by means of the Villalta–Pradoni scale before and 6 months after the operation. Instrumental methods of study included ultrasound duplex scanning (USDS), magnetic resonance and/or multispiral computed venography, and contrast-enhanced X-ray venography.

The technical success of the procedure amounted to 91%. In one patient with occlusion of the common and external iliac veins we failed to perform recanalization and stenting. A further one patient developed in-stent and CFV thrombosis on the second postoperative day. An attempt of catheter thrombolysis turned out unsuccessful. There were no wound complications in the postoperative period. Neither was pulmonary artery thromboembolism registered. The dynamic control was carried out by means of USDS before discharge from hospital and at 1, 3 and 6 months after the intervention. The outcomes of hybrid operations after 6 months were followed up in five patients. Secondary patency rate of the stented iliac veins amounted to 100%. No relapses of trophic ulcers were observed. According to the Villalta-Prandoni scale the value of the median of the composite index decreased from 15 to 7 (p=0.012).

The first experience with hybrid operations for obstructive lesions of veins of the iliac-femoral segment demonstrated their high efficacy and safety. Efficiency of the operation was confirmed by significant clinical improvement and good results of patency of the restored-repaired segments of veins.

KEY WORDS: post-thrombotic disease, chronic obstruction of iliac-femoral segment veins, hybrid operations.

P. 138

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