Jundishapur Scientific Medical Journal

Jundishapur Scientific Medical Journal

Outcomes of Venoplasty with Stent Implantation in Patients with Chronic Venous Symptoms following Deep Vein Thrombosis in the Iliofemoral Segment

Document Type : Original Article

Authors
Department of Surgery, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
10.32592/JSMJ.23.2.114
Abstract
Background and Objectives Deep vein thrombosis (DVT) is a common vascular condition that affects 1 to 3 per 1,000 people annually. Proximal thrombosis (including iliac veins) poses a higher risk for postthrombotic syndrome (PTS). Therefore, the present study investigated the outcomes of venoplasty with stent placement in patients with chronic venous symptoms following DVT in the iliofemoral segment. Subjects and Methods This cross-sectional study included patients with an age range of 20 to 70 years who presented with chronic symptoms of iliofemoral obstructive venous lesion following DVT. They received local anesthesia with lidocaine, and if necessary, by venous sedation under lower extremity venography using catheter with popliteal vein surgery on the same side and placement of a sheet. Pre-intervention and six-month post-intervention data on relevant variables were collected, documented, and subjected to analysis. Results Of the 24 patients participating in the study, 70.8% were male and 29.2% were female with a mean age of 51.42 ± 8.27 years. There was a significant difference in pain and wound condition before and 6 months after the intervention (P <0.001). After the intervention, 58.3% of the patients were in painless condition, and the frequency of patients without wounds increased from 12.5% to 66.7%. Edema changes were not significant (P = 0.29) Conclusion Stent placement for patients experiencing chronic venous symptoms secondary to iliofemoral DVT demonstrates efficacy in pain reduction and wound healing, establishing itself as a practical and user-friendly treatment approach.
Keywords
Subjects

[1] Guanella R, Ducruet T, Johri MM, MIRON MJ, Roussin A, Desmarais S, Joyal F, Kassis J, Solymoss S, Ginsberg JS, Lamping DL. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation. Journal of Thrombosis and Haemostasis. 2011 Dec 1;9(12):2397-405. [10.1111/j.1538-7836.2011.04516.x] [PMID]
[2] Kahn SR, Comerota AJ, Cushman M, Evans NS, Ginsberg JS, Goldenberg NA, Gupta DK, Prandoni P, Vedantham S, Walsh ME, Weitz JI. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2014 Oct 28;130(18):1636-61. [10.1161/CIR.00000000000 00130] [PMID]
[3] Bernardi E, Prandoni P. The post-thrombotic syndrome. Current opinion in pulmonary medicine. 2000 Jul 1;6(4):335-42. [10.1097/00063198-200007000-00015] [PMID]
[4] Kahn SR, Ginsberg JS. The post-thrombotic syndrome: current knowledge, controversies, and directions for future research. Blood reviews. 2002 Sep 1;16(3):155-65. [10.1016/s0268-960x(02)00008-5] [PMID]
[5] Saarinen J, Kallio T, Lehto M, Hiltunen S, Sisto T. The occurrence of the post-thrombotic changes after an acute deep venous thrombosis: a prospective two-year follow-up study. Journal of Cardiovascular Surgery. 2000 Jun 1;41(3):441. [PMID]
[6] Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the postthrombotic syndrome. Archives of internal medicine. 2004 Jan 12;164(1):17-26. [10.1001/ archinte.164.1.17] [PMID]
[7] Prandoni P, Kahn SR. Post‐thrombotic syndrome: prevalence, prognostication and need for progress. British journal of haematology. 2009 May;145(3):286-95. [10.1111/j.1365-2141.2009.07601.x] [PMID]
[8] Douketis JD, Crowther MA, Foster GA, Ginsberg JS. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis?. The American journal of medicine. 2001 May 1;110(7):515-9. [10.1016/s0002-9343(01)00661-1] [PMID]
[9] Meissner MH, Eklof B, Smith PC, Dalsing MC, DePalma RG, Gloviczki P, Moneta G, Neglén P, O’Donnell T, Partsch H, Raju S. Secondary chronic venous disorders. Journal of vascular surgery. 2007 Dec 1;46(6):S68-83. [10.1016/j.jvs.2007.08.048] [PMID]
[10] Augustinos P, Ouriel K. Invasive approaches to treatment of venous thromboembolism. Circulation. 2004 Aug 31;110 (9_suppl_1):I-27. [10.1161/01.CIR.0000140900.64198.f4] [PMID]
[11] Kamphausen M, Barbera L, Mumme A, Marpe B, Grossefeld M, Asciutto G, Geier B. Clinical and functional results after transfemoral thrombectomy for iliofemoral deep venous thrombosis: a 5-year-follow-up. Zentralblatt fur Chirurgie. 2005 Oct 1;130(5):454-61. [10.1055/s-2005-836874] [PMID]
[12] Markel A, editor Origin and natural history of deep vein thrombosis of the legs. Seminars in vascular medicine; 2005: Copyright© 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New.[ 10.1055/s-2005-871743] [PMID]
[13] Monreal M, Barba R, Tolosa C, Tiberio G, Todolí J, Samperiz AL. Deep vein thrombosis and pulmonary embolism: the same
disease?. Pathophysiology of haemostasis and thrombosis. 2006;35(1-2):133-5. [10.1159/000093555] [PMID]
[14] Bergan JJ. A major step forward in the treatment of venous occlusion. Journal of Endovascular Therapy. 2000 Apr;7(2):92-3. [10.1177/152660280000700202] [PMID]
[15] Neglén P, Hollis KC, Olivier J, Raju S. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. Journal of vascular surgery. 2007 Nov 1;46(5):979-90. [10.1016/j.jvs.2007.06.046] [PMID]
[16] Kolbach DN, Sandbrink MW, Hamulyak K, Prins MH, Neumann MH. Non‐pharmaceutical measures for prevention of post‐thrombotic syndrome. Cochrane Database of Systematic Reviews. 2003(3). [10.1002/14651858.CD004174.pub2] [PMID]
[17] Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. Journal of thrombosis and thrombolysis. 2009 Nov;28:465-76. [10.1007/s11239-009-0309-3] [PMID]
[18] Enden T, Haig Y, Kløw NE, Slagsvold CE, Sandvik L, Ghanima W, Hafsahl G, Holme PA, Holmen LO, Njaastad AM, Sandbæk G. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. The Lancet. 2012 Jan 7;379(9810):31-8. [10.1016/S0140-6736(11)61753-4] [PMID]
[19] Kurklinsky AK, Bjarnason H, Friese JL, Wysokinski WE, McBane RD, Misselt A, Moller SM, Gloviczki P. Outcomes of venoplasty with stent placement for chronic thrombosis of the iliac and femoral veins: single-center experience. Journal of Vascular and Interventional Radiology. 2012 Aug 1;23(8):1009-15. [10.1016/j.jvir.2012.04.019] [PMID]
[20] Razavi MK, Jaff MR, Miller LE. Safety and effectiveness of stent placement for iliofemoral venous outflow obstruction: systematic review and meta-analysis. Circulation: Cardiovascular Interventions. 2015 Oct;8(10):e002772. [10.1161/CIRCINTERVENTIONS.115.002772] [PMID]
[21] Sarici IS, Yanar F, Agcaoglu O, Ucar A, Poyanli A, Cakir S, Aksoy SM, Kurtoglu M. Our early experience with iliofemoral vein stenting in patients with post-thrombotic syndrome. Phlebology. 2014 Jun;29(5):298-303. [10.1177/0268355513477641] [PMID]
[22] Titus JM, Moise MA, Bena J, Lyden SP, Clair DG. Iliofemoral stenting for venous occlusive disease. Journal of vascular surgery. 2011 Mar 1;53(3):706-12. [10.1016/j.jvs.2010.09.011] [PMID]
[23] Ye K, Lu X, Yang X, Li W, Huang Y, Huang X, Lu M. Technical details and clinical outcomes of transpopliteal venous stent placement for postthrombotic chronic total occlusion of the iliofemoral vein. Journal of Vascular and Interventional Radiology. 2014 Jun 1;25(6):925-32. [10.1016/j.jvir.2014.02. 031] [PMID]
[24] Agnelli G. Current issues in anticoagulation. Pathophysiology of Haemostasis and Thrombosis. 2005;34(Suppl. 1):2-9. [10. 1159/000083078] [PMID]
[25] Comerota AJ, Gravett MH. Iliofemoral venous thrombosis. Journal of vascular surgery. 2007 Nov 1;46(5):1065-76. [10. 1016/j.jvs.2007.06.021 ] [PMID]
[26] Heit JA. Epidemiology of venous thromboembolism. Nature Reviews Cardiology. 2015 Aug;12(8):464-74. [10.1038/
122
Mousavi S M, et al. Venoplasty with Stent Implantation in Patients with Chronic Venous Symptoms. JSMJ. 2024; 23(2):114-122
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Scientific Medical Journal
May & June 2024. Vol 23. No 2
nrcardio.2015.83] [PMID]
[27] Murphy KD. Mechanical thrombectomy for DVT. Techniques in Vascular and Interventional Radiology. 2004 Jun 1;7(2):79-85. [10.1053/j.tvir.2004.05.002] [PMID]
[28] Singh H, Masuda EM. Comparing short-term outcomes of femoral-popliteal and iliofemoral deep venous thrombosis: early lysis and development of reflux. Annals of vascular surgery. 2005 Jan 1;19(1):74-9. [10.1007/s10016-004-0133-3] [PMID]
[29] Yamaki T, Nozaki M. Patterns of venous insufficiency after an acute deep vein thrombosis. Journal of the American College of Surgeons. 2005 Aug 1;201(2):231-8. [10.1016/j.jamcollsurg. 2004.12.014] [PMID]
[30] Mozafar M, Talebianfar M, Molaee H. Long Term Outcomes of Systemic Anticoagulation Treatmentfor Deep Vein Thrombosis in Shohadaye Tajrish Hospital During Five Years Iranian Journal of Surgery. 2009;17(2):32-8.
[31] Falcoz MT, Falvo N, Aho-Glélé S, Demaistre E, Galland C, Favelier S, Pottecher P, Chevallier O, Bonnotte B, Audia S, Samson M. Endovascular stent placement for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions: a single-center study of safety, efficacy and quality-of-life improvement. Quantitative imaging in medicine and surgery. 2016 Aug;6(4):342. [10.21037/qims.2016.07.07] [PMID]
[32] Moini M, Zafarghandi MR, Taghavi M, Salimi J, Tadayon B, Mohammad Sadat SA, Farshidmehr P, Noaparast M. Venoplasty and stenting in post-thrombotic syndrome and non-thrombotic iliac vein lesion. Minimally Invasive Therapy & Allied Technologies. 2020 Jan 2;29(1):35-41. [10.1080/136 45706.2019.1580748] [PMID]
[33] Guillen K, Falvo N, Nakai M, Chevallier O, Aho-Glélé S, Galland C, Demaistre E, Pescatori L, Samson M, Audia S, Bonnotte B. Endovascular stenting for chronic femoro-iliac venous obstructive disease: clinical efficacy and short-term outcomes. Diagnostic and Interventional Imaging. 2020 Jan 1;101(1):15-23. [10.1016/j.diii.2019.03.014] [PMID]
[34] Van Vuuren TM, de Wolf MA, Arnoldussen CW, Kurstjens RL, van Laanen JH, Jalaie H, de Graaf R, Wittens CH. Editor's choice–reconstruction of the femoro-ilio-caval outflow by percutaneous and hybrid interventions in symptomatic deep venous obstruction. European Journal of Vascular and Endovascular Surgery. 2017 Oct 1;54(4):495-503. [10.1016/ j.ejvs.2017.06.023] [PMID]
[35] Hartung O, Otero A, Boufi M, Decaridi G, Barthelemy P, Juhan C, Alimi YS. Mid-term results of endovascular treatment for symptomatic chronic nonmalignant iliocaval venous occlusive disease. Journal of Vascular Surgery. 2005 Dec 1;42(6):1138-43. [10.1016/j.jvs.2005.08.012] [PMID]
[36] Schwarzbach MH, Schumacher H, Böckler D, Fürstenberger S, Thomas F, Seelos R, Richter GM, Allenberg JR. Surgical thrombectomy followed by intraoperative endovascular reconstruction for symptomatic ilio-femoral venous thrombosis. European journal of vascular and endovascular surgery. 2005 Jan 1;29(1):58-66. [10.1016/j.ejvs.2004.09.022] [PMID]
[37] Nicolaides AN, Allegra C, Bergan J, Bradbury A, Cairols M, Carpentier P, Comerota A, Delis C, Eklof B, Fassiadis N, Georgiou N. Management of chronic venous disorders of the
lower limbs guidelines according to scientific evidence. International angiology. 2008 Feb 1;27(1):1. [PMID]
Volume 23, Issue 2 - Serial Number 149
May and June 2024
Pages 114-122

  • Receive Date 09 December 2023
  • Revise Date 25 February 2024
  • Accept Date 13 April 2024