Surgical Thrombectomy for Treatment of Acute Iliofemoral Venous Thrombosis

Objective : To assess the effectiveness of open surgical thrombectomy in acute iliofemoral venous thrombosis. Methods: Between January 2012 and October 2018, a total of 65 patients underwent transfemoral venous thrombectomy (VT) in acute iliofemoral venous thrombosis. Ten patients received a venous hybrid operation comprising balloon- catheter thrombectomy and stenting of residual stenosis of iliac vein. The control group consisted of 44 patients who received standard anticoagulant therapy. The results were evaluated by duplex ultrasound (DUS). The assessment of clinical effectiveness was made with Venous Clinical Severity Score (VCSS), Villalta Score and health-related quality of life (HRQoL). Results: Secondary patency of iliofemoral segment at 6 months of monitoring after thrombectomy was reported in 97% of cases. Meanwhile, the recanalization of iliofemoral segment was registered only in 27% ( P < .0001) of patients who had anticoagulant therapy alone . The median preoperative VCSS was 7, which dropped to 2 at 6 months ( P =.002). There were five cases of successful re-thrombectomy and stenting (three cases). Сumulative primary and secondary patency rates of iliofemoral veins at 72 months were 88% and 95%, respectively. The data Villalta score in long-term follow-up in patients after surgery was significantly lower than of patients treated with anticoagulation ( P < .001). HRQoL of patients after 6 years of VT was improved, its mean score decreased from 45.3 (8.6) to 23.6 (6.1; P < .001). Conclusion: According to selective indications open surgical thrombectomy in iliofemoral venous thrombosis with using current methods of deep vein restoration patency increases the effectiveness of treatment of this severe pathology and prevents from progression of postthrombotic syndrome.