Open surgery for iliofemoral deep vein thrombosis with temporary arteriovenous fistula remains valuable

Abstract

Objective We assessed outcomes of open surgical venous thrombectomy with temporary arteriovenous fistula, and the procedure's effect on health-related quality of life. Method We retrospectively analyzed 48 (26 at long-term) patient medical records. Mortality rates, patency, and risk of post-thrombotic syndrome were analyzed using Kaplan-Meier estimation. The association between risk factors/coagulation disorders and patency/post-thrombotic syndrome along with patient health-related quality of life at long-term was analyzed employing various statistical methods. Results Patient one-year survival rate was 93 ± 4% and primary one-year patency rate was 89 ± 5% (secondary one-year patency rate 97 ± 3%). Freedom from post-thrombotic syndrome after eight years was 80 ± 12% (post-thrombotic syndrome rate 20 ± 12%). Health-related quality of life was impaired vs. normative data in the physical and social subscales, and in the mental component score ( p < .05). Conclusions Open surgical venous thrombectomy appears safe compared with literature-reported outcomes in similar patients using alternative approaches. Iliofemoral deep vein thrombosis impairs physical, social, and mental health-related quality of life.

Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

“…These data have been confirmed by others and by our previously published results [1,13,16]. For example, Hölper et al reported primary and secondary patency rates after a mean follow-up of 64 month of 74% and 84% respectively [1] and Wagenhäuser et al described primary patency rates of 89% after a mean follow-up of 63 month [13]. Despite these excellent patency rates, we identified four patients with an occlusion of the iliac-or common femoral vein and one patient demonstrated an occlusion of the femoral vein with a patent iliofemoral segment.…”

“…Only Plate et al reported 10 year results prospectively and a patency rate of 83% after surgical thrombectomy [12]. These data have been confirmed by others and by our previously published results [1,13,16]. For example, Hölper et al reported primary and secondary patency rates after a mean follow-up of 64 month of 74% and 84% respectively [1] and Wagenhäuser et al described primary patency rates of 89% after a mean follow-up of 63 month [13].…”

“…This may indicate, that once a patient is treated successfully, the veins will remain patent. Other authors observed lower occlusion rates of 8.3% [13]. However, the initially enrolled 67 patients had a 48% loss of follow-up, which is another limitation of this study.…”

“…Therefore we are unable to make use of a statistical compensation for the lost to follow-up patients. Nevertheless, comparable studies in the last years had a smaller number of patients [1,13,15,17]. Nearly the half of our treated patients had reflux in the deep venous system.…”

“…Thus, a subgroup analysis of this study shows a benefit in the reduction of severe PTS for the use of pharmacomechanical catheter-directed thrombolysis, limited to patients with an iliofemoral DVT [11]. However, there have been demonstrated good results for surgical thrombectomy of iliofemoral DVT in terms of prevention of PTS as well [1,8,[12][13][14][15][16][17]. Even though duplex ultrasound mapping is the gold standard in the diagnosis of venous diseases including PTS [18], other noninvasive diagnostic methods e.g.…”