Femoral endovenectomy with endoluminal iliac vein recanalization in chronic venous occlusion

Objective
Chronic post-thrombotic iliofemoral obstruction is associated with debilitating morbidity. Venoplasty and stenting are often successful; however, in the presence of a diseased or occluded common femoral vein (CFV), failure is common. A hybrid operative procedure of open surgical CFV endovenectomy and endoluminal recanalization of the obstructed iliofemoral segment has been developed. The purpose of this report was to report safety and efficacy of this procedure in patients with incapacitating post-thrombotic iliofemoral venous obstruction.
Methods
Twenty-three patients undergoing CFV endovenectomy with endoluminal reconstruction (iliac, inferior vena cava) were analyzed. These patients were evaluated by full history taking, laboratory investigation, especially thrombophilia assessment, and imaging investigations, especially duplex scan and computed tomographic venography (CTV) with a comparison between pre- and postoperative clinical, etiology, anatomy, pathophysiology clinical classification, the Venous Clinical Severity Score (VCSS), and the Villalta Scale.
Results
Male sex was found in 15 (65.2%), while 34.8% (=8) were females. The mean age of the study patients was 36±7.2 years (range: 22–49). Patients with active venous ulcer (C6) were the most prevalent in this study (47.8%). Significant improvement in the clinical signs and symptoms of all patients could be demonstrated, as all patients with active venous ulcer were healed during the follow-up period. Both VCSS and Villalta score show a marked decrease at 12 months of follow-up, with a median of about 6-point decrease in Villalta score and a median of about 7point decrease in VCSS. Complications: Major bleeding was present in four patients (20%), while minor bleeding was found in one patient (5.0%). Seroma was evident in four patients (20%). Early thrombosis of the endovenctomatized segment and stents occurred in two patients (10%) and contralateral DVT was reported in one patient (5.0%).
Conclusions
Femoral endovenectomy with intraoperative endoluminal recanalization of the iliac vein is effective and safe in the treatment of patients with incapacitating post-thrombotic iliofemoral venous obstruction.