Indications for endophlebectomy and/or arteriovenous fistula after stenting

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Vascular Medicine

Background:

• Endovenous recanalization with angioplasty and stenting is increasingly used for iliocaval obstruction in post-thrombotic syndrome.
• Stenting success is compromised if distal inflow is inadequate, particularly when obstruction extends below the inguinal ligament.
• Ensuring adequate inflow may require treating diseased common femoral, femoral, and profunda femoral veins.

Purpose of the Study:

• To evaluate the utility of duplex ultrasonography, magnetic resonance venography, and conventional venography in assessing inflow trajectory for complex post-thrombotic disease.
• To describe experience with endophlebectomy and arteriovenous fistula creation for improving inflow in iliocaval stenting.
• To highlight the need for criteria to accurately assess pre- and postinterventional flow.

Main Methods:

• Review of patient cases undergoing endovenous recanalization for iliocaval obstruction.
• Preoperative assessment of inflow using duplex ultrasonography, magnetic resonance venography, and conventional venography.
• Surgical intervention including endophlebectomy and concurrent arteriovenous fistula creation when indicated.

Main Results:

• Detailed description of imaging techniques used to evaluate inflow.
• Discussion of endophlebectomy and arteriovenous fistula as options for inflow improvement.
• Emphasis on the difficulty in preoperative prediction of inflow and the need for established criteria.

Conclusions:

• Accurate assessment of inflow trajectory is crucial for successful iliocaval stenting in complex post-thrombotic syndrome.
• Endophlebectomy and arteriovenous fistula creation are viable options to ensure adequate inflow.
• Further research is needed to establish criteria for assessing venous flow before and after interventions.