[Stent implantation after thrombectomy of pelvic veins. Indications, results]

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.

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.

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%).

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.