Courtney J. Warner, Daniel B. Walsh, Philip P. Goodney, Brian W. Nolan, Eva M. Rzucidlo, Andrew W. Hoel, Richard J. Powell, David H. Stone
Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
OBJECTIVES: Though previous reports have demonstrated the efficacy of catheter-directed thrombolytic therapy and iliac vein stenting for the management of iliofemoral DVT, functional outcomes remain undefined. The purpose of this study was to determine long term outcomes and functional quality of life among patients treated with iliac vein stenting.
METHODS: Records of all patients treated with iliac vein stent placement between March 2006 and March 2011 were examined for primary patency, assisted primary patency, and long term functional outcomes including presence of symptoms and return to their pre-DVT level of activity. Follow-up via telephone interview and clinic visit allowed quantitative comparison of functional status pre and postoperatively.
RESULTS: Over the study interval, 32 patients (33 limbs) underwent iliac vein stent placement. 72% (n=23) of these patients were female, with an average age of 43 years. 78% of patients (n=25) were diagnosed with acute DVT, 89% of which occurred in the left leg. Catheter-directed thrombolysis was utilized in 92% of patients (23 of 25) with acute DVT. All patients treated with lysis and stenting presented with pain and edema in the affected limb; 20% presented with phlegmasia. One year primary patency and assisted primary patency were 84% and 90% respectively. Freedom from reintervention at 1 year was 83%. Treatment was associated with a sustained significant reduction in pain (91% vs. 6%, p<.001) and edema (97% vs. 12%, p<.001) at a mean follow-up of 29 months (range 5-83 months), at which time 89% of patients reported to be at their baseline pre-DVT functional status with return to work.
CONCLUSIONS: Aggressive therapy of symptomatic iliac vein stenosis or occlusion with venography, catheter-directed thrombolysis, and iliac vein stent placement provides durable patency and freedom from reintervention. Most patients can anticipate good functional recovery with decreased pain and edema and the capability to return to their previous employment.
AUTHOR DISCLOSURES: P. P. Goodney, Nothing to disclose; A. W. Hoel, Nothing to disclose; B. W. Nolan, Nothing to disclose; R. J. Powell, Nothing to disclose; E. M. Rzucidlo, Nothing to disclose; D. H. Stone, Nothing to disclose; D. B. Walsh, Nothing to disclose; C. J. Warner, Nothing to disclose
Posted April 2012