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  • Title: [Stent implantation after thrombectomy of pelvic veins. Indications, results].
    Author: Mickley V, Schwagierek R, Schütz A, Sunder-Plassmann L.
    Journal: Zentralbl Chir; 1999; 124(1):12-7. PubMed ID: 10091291.
    Abstract:
    PURPOSE: Retrospective study on frequency of iliac venous stenoses that are cause (venous spur) or consequence (postoperative or postthrombotic) of iliofemoral thrombosis, and on the results of interventional treatment. METHODS: From 1990 through 1996, 76 patients were operated on for acute iliac vein thromboses. All patients had transfemoral venous thrombectomy with creation of an inguinal av-fistula. Immediate results of thrombectomy were documented by intraoperative completion venogram. Since 1995 venous spurs eventually detected during thrombectomy were immediately treated by stent implantation. Before scheduled closure of the av-fistula at three months, cross-over arteriovenography was performed. Additional significant iliofemoral venous stenoses were also treated interventionally at this time. RESULTS: 42 hemodynamically significant iliofemoral venous stenoses were found in 38 (50%) patients. Intraoperative phlebography revealed left common iliac vein obstructions suggestive of venous spurs in 30 patients (49% of left-sided thromboses). At three months, five patients (7%) had postthrombotic iliac vein stenoses, and seven patients (9%) had postoperative common femoral vein stenoses. A total of 26 stents were implanted into 20 stenoses (eight spurs, all postthrombotic and postoperative stenoses). There was an acute re-occlusion due to a technical error during stent implantation. In all other patients, the venous lumen could be completely restored. Three of four re-stenoses (at 3, 4, 7, and 12 months) were successfully treated by another intervention. We observed one late failure at 60 months. Cumulative primary (secondary) five-year patency rate (Kaplan-Meier) is 72% (88%). CONCLUSION: For venous spurs as well as for postthrombotic or postoperative venous stenoses, stent implantation can be recommended as a simple, safe, and durable means to prevent rethrombosis.
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