Factors affecting outcome of open and hybrid reconstructions for nonmalignant obstruction of iliofemoral veins and inferior vena cava

• Published in: Journal of vascular surgery Vol. 53; no. 2; pp. 383 - 393
• Main Authors: Garg, Nitin, MBBS, MPH, Gloviczki, Peter, MD, Karimi, Kamran M., MD, Duncan, Audra A., MD, Bjarnason, Haraldur, MD, Kalra, Manju, MBBS, Oderich, Gustavo S., MD, Bower, Thomas C., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Angioplasty - adverse effects; Angioplasty - instrumentation; Angioplasty - mortality; Biological and medical sciences; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Chronic Disease; Diseases of the cardiovascular system; Female; Femoral Vein - diagnostic imaging; Femoral Vein - physiopathology; Femoral Vein - surgery; Humans; Iliac Vein - diagnostic imaging; Iliac Vein - physiopathology; Iliac Vein - surgery; Magnetic Resonance Angiography; Male; Medical sciences; Middle Aged; Minnesota; Phlebography; Polytetrafluoroethylene; Proportional Hazards Models; Prosthesis Design; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Assessment; Risk Factors; Saphenous Vein - transplantation; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Grafting - adverse effects; Vascular Grafting - mortality; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vena Cava, Inferior - diagnostic imaging; Vena Cava, Inferior - physiopathology; Vena Cava, Inferior - surgery; Venous Thrombosis - diagnosis; Venous Thrombosis - mortality; Venous Thrombosis - physiopathology; Venous Thrombosis - surgery; Venous Thrombosis - therapy; Young Adult; Cardiovascular disease; Prognosis; Iliofemoral; Obstruction; Surgery; Inferior vena cava
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2010.08.086

Objectives To identify factors affecting long-term outcome after open surgical reconstructions (OSR) and hybrid reconstructions (HR) for chronic venous obstructions. Methods Retrospective review of clinical data of 60 patients with 64 OSR or HR for chronic obstruction of iliofemoral (IF) veins or inferior vena cava (IVC) between January 1985 and September 2009. Primary end points were patency and clinical outcome. Results Sixty patients (26 men, mean age 43 years, range 16-81) underwent 64 procedures. Ninety-four percent had leg swelling, 90% had venous claudication, and 31% had active or healed ulcers (CEAP classes: C3 = 30, C4 = 12, C5 = 8, C6 = 12). Fifty-two OSRs included 29 femorofemoral (Palma vein: 25, polytetrafluoroethylene [PTFE]: 4), 17 femoroiliac-inferior vena cava (IVC) (vein: 3, PTFE: 14) and six complex bypasses. Twelve patients had HR, which included endophlebectomy, patch angioplasty, and stenting. Early graft occlusion occurred after 17% of OSR and 33% HR. Discharge patency was 96% after OSR, 92% after HR. No mortality or pulmonary embolism occurred. Five-year primary and secondary patency was 42% (95% confidence interval [CI] 29%-55%) and 59% (CI 43%-72%), respectively. For Palma vein grafts it was 70% and 78%, for femoroiliac and ilio-infrahepatic IVC bypasses it was 63% and 86%, and for femoro-infrahepatic IVC bypasses it was 31% and 57%, respectively. Complex OSRs and hybrid procedures had 28% and 30% 2-year secondary patency, respectively. The only factor that significantly affected graft patency in multivariate analysis was May-Thurner syndrome with associated chronic venous thrombosis. For HR, stenting into the common femoral vein patch vs iliac stents only significantly increased patency. At last follow-up, 60% of the patients had no venous claudication and no or minimal swelling. All ulcers with patent grafts healed but 50% of these recurred. Conclusions Both OSR and HR are viable options if endovascular procedures fail or are not feasible. Palma vein bypass and femoroiliac or iliocaval PTFE bypasses have excellent outcomes with good symptomatic relief.