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Online ISSN 1827-1847
CONTROVERSIES IN VENOUS DISEASES
Alimi Y. S., Hartung O.
Service of Vascular Surgery, Nord University Hospital, Marseille, France
Aim. To report the long-term results of stenting for chronic ilio-caval obstruction lesions.
Methods. From January 1996 to January 2009, 96 patients (78 women and 18 men; median age: 43 years) were admitted for endovascular treatment of chronic symptomatic disabling non-malignant obstructive ilio-caval lesions. Patients were classified as C2s in 17 cases, C3s in 61, C4s in 9, C5s in 3 and C6s in 6, median preoperative venous disability score (VDS) was 2 (range: 2-3) and venous clinical severity score was 9 (range: 4 -25). Etiology was primary in 57 patients, secondary in 37 and congenital in 2. Venous lesions were bilateral in 8 cases, 10 patients had inferior vena cava involvement and 21 had common femoral vein obstructive lesions. Complete venous occlusion was found in 33 cases (34%).
Results. Technical success was achieved in 98 %, due to recanalisation failure in 2 cases. The median hospital stay was 2 days (range: 1-14 days). Primary and secondary patency rates at 30 days were respectively 96 % and 97 %. Five postoperative complications (5.2 %) occurred: 2 thromboses after iliac vein recanalisation for post-thrombotic disease (both with common femoral vein involvement), one right hemothorax (due to stent migration) and 2 haematomas at access site with no need of surgical treatment. Median follow-up was 44 months (5- 156) and no patient was lost. Late complications (6.25 %) included one non-related death at 16 months (peritoneal carcinosis caused by colic cancer) and 5 cases of thromboses occurred. Iterative stenting was performed for restenosis in 6 cases. Primary, primary-assisted and secondary patency rates, in terms of intention to treat, were 83 %, 89 % and 93 %, respectively, at 3 and 5 years, with a mean VDS of 1.
Conclusions. Venous angioplasty and stenting is a safe, effective and minimally invasive technique which provides good long-term results. Currently, it is recognized as the technique of choice for the treatment of chronic femoro-ilio-caval obstructive lesions. Surgery should be proposed only in case of failure.