New Hybrid Procedure Shows Improved Patency of Iliofemoral Stenting in Patents With Compromised Infrainguinal Inflow Vessels in Post-Thrombotic Chronic Venous

Iliac stenting of post-thrombotic chronic venous obstruction is an established form treatment with good results, but iliofemoral has had variable success, believed to be due poor inflow and some have been deterred from below the inguinal ligament all together these limitations. We attempted optimize by surgically removing septae in common femoral vein before flush at confluence. In a retrospective analysis our own previously published material (2018), where we performed stenting, identified subgroup patients (group A) that compromised infrainguinal vessels. These were period treated dominant vessel. The stent patency this group was 58 % after 2 years. Revisiting magnetic resonance venography (MRV) pictures showed choosing single vessel could exclude other sources intravenous septae. Consequently, changed approach introducing hybrid procedure. This includes endophlebectomy 2-cm segment above confluence, resecting fibrotic tissue collecting possible inflow. Then deploying self-expanding Here present retrospective, preliminary first eight B) method during September 2018 October 2020. B same vessels as A, verified comparison MRV. 1:1 men women, median age 51 years (range, 28-74 years), clinical status categorized based on CEAP VCSS. Preoperative MRV patients. postoperative follow-up 29.5 months 17-42 months). Postoperative controls assessed duplex ultrasound examination, for severe obesity computed tomography used. Endophlebectomy placement successful Early occlusion occurred three mechanical thrombectomy these. one patient, adjunctive extension necessary. another heparin-induced thrombocytopenia, requiring low-molecular-weight heparin replaced fondaparinux. One remained occluded. patient required open surgery evacuate hematoma without any consequence stenting. Primary achieved patients, primary assisted four, secondary seven Stenting endophlebectomized confluence secure adequate may improve when ligament.