Endovenectomy of the common femoral vein and intraoperative iliac vein recanalization for chronic iliofemoral venous occlusion.

Chronic postthrombotic occlusion of the iliofemoral venous segments produces severe morbidity, which can be alleviated if venous drainage is restored. The common femoral vein (CFV) cannot always be fully recanalized with percutaneous endovenous techniques alone. We report the technique combining operative endovenectomy and patch venoplasty of the CFV with intraoperative iliac vein venoplasty and stenting to restore unobstructed venous drainage from the infrainguinal venous system to the vena cava. This procedure led to reduced pain, edema, and healing of a long-standing venous ulcer, with a marked reduction in postthrombotic morbidity.

Quantity of clot lysed after catheter-directed thrombolysis for iliofemoral deep venous thrombosis correlates with postthrombotic morbidity.

BACKGROUND: International treatment guidelines now recognize the importance of thrombus removal to reduce postthrombotic morbidity when treating patients with extensive acute deep venous thrombosis (DVT). Studies have shown that thrombus resolution with catheter-directed thrombolysis in patients with iliofemoral DVT reduces postthrombotic morbidity, although patients unsuccessfully treated with catheter-directed thrombolysis (CDT) do not enjoy the same long-term benefit. The purpose of this study is to objectively assess whether the amount of clot reduction at the time of acute therapy correlates with long-term postthrombotic morbidity. METHODS: Forty-two patients who underwent catheter-directed and/or pharmacomechanical lysis of iliofemoral DVT were quantitatively evaluated. Patients had their degree of clot lysis quantified and were divided into two main groups for comparison. Group I (n = 33) had >50% clot lysis (mean, 84%) and group II (n = 9) had < or =50% lysis (mean, 42%). At a mean follow-up interval of 14 months, the degree of chronic venous disease was assessed by evaluators blinded to the degree of clot lysis. Evaluation of postthrombotic morbidity was performed using the Villalta scale, and the clinical class of CEAP, and quality-of-life (QOL) was assessed using the Short Form Health Survey (SF-36). RESULTS: Mean CEAP scores were 0.85 and 3.13 (P = .005), and Villalta scores were 2.38 and 6.25 (P = .009) in group I and group II, respectively. Patient QOL in group I was higher than group II in all parameters. Physical functioning (P = .035), role physical (P = .012), general health (P = .014), vitality (P < .001), and social functioning (P = .012) were all significantly better in group I. Bodily pain (P = .117), role emotional (P = .624), and mental health (P = .096) strongly favored group I patients but did not reach statistical significance. CONCLUSION: Patients with extensive DVT treated with catheter-based interventions to eliminate thrombus suffer relatively little postthrombotic morbidity. The degree of clot lysis directly correlates with long-term outcome. Improved QOL, the Villalta scale, and clinical class of CEAP are linearly correlated with the amount of clot resolution.