Endovenectomy of the common femoral vein and intraoperative iliac vein recanalization for chronic iliofemoral venous occlusion

Abstract

Chronic postthrombotic occlusion of the iliofemoral venous segments produces severe morbidity, which can be alleviated if venous drainage is restored. The common femoral vein (CFV) cannot always be fully recanalized with percutaneous endovenous techniques alone. We report the technique combining operative endovenectomy and patch venoplasty of the CFV with intraoperative iliac vein venoplasty and stenting to restore unobstructed venous drainage from the infrainguinal venous system to the vena cava. This procedure led to reduced pain, edema, and healing of a long-standing venous ulcer, with a marked reduction in postthrombotic morbidity.

Common femoral endovenectomy with iliocaval endoluminal recanalization improves symptoms and quality of life in patients with postthrombotic iliofemoral obstruction

“…Although the technical details have been previously reported, 15 several key elements are worth emphasizing. Complete control of all branches of the CFV is mandatory, as endovenectomy must be performed in a completely dry field.…”

Arteriovenous fistula geometry in hybrid recanalisation of post-thrombotic venous obstruction

“…5 These types of patients can be treated by endophlebectomy of the common femoral vein (CFV) and orifices of all significant veins draining into the CFV, in addition to PTA and stenting of the more proximal tract. 4,[6][7][8] To ensure proper inflow of the recanalised tract and prevent early thrombotic complications, an arteriovenous fistula (AVF) can be placed between the common femoral artery (CFA) and the CFV. 4,[9][10][11] Use of such an AVF can be counterproductive, though, since stenosis or occlusion in the region of the venous anastomosis of the AVF has been observed in our centre.…”

Regarding “Endovenectomy of the common femoral vein and intraoperative iliac vein recanalization for chronic iliofemoral venous occlusion”

“…The results of our analysis suggest that crossing of survival curves of EVAR and OSR occurs even in randomized cohorts though the intersection is delayed by approximately one year as compared with the retrospective cohorts in the study by Goodney et al 1 To confirm whether the differences in mortality after the crossing are increased, longer-term results of randomized trials would be needed.…”