Stentgestützte perkutane Therapie bei Beckenvenenstenosen nach operativer Thrombektomie und Shuntanlage

Abstract

Among 15 patients with acute thrombotic disease of pelvic veins who had been submitted to operative thrombectomy and creation of arteriovenous fistula in the groin, 12 presented with stenotic lesions 3 months later. These stenoses were submitted to percutaneous angioplasty. If angioplasty failed, percutaneous placement of a vascular stent (wall stent) was performed immediately (n = 7). Stenting in cross-over-technique proved practicable in all cases. Secondary stenotic disease in the exclusively dilated area was observed in 3/5 cases and was also treated with a wall stent. In one patient with recurrent stenoses who refused stenting, extended thrombosis occurred after occlusion of the AV-fistula. At mid-term PTA was successful in only two cases. Intimal hyperplasia was observed in only one wall stent treated patient. Percutaneous treatment of iliacal stenoses in patients with postthrombotic syndrome may be performed safely under the protective effect of the fistula. With the presented technique, patency of pelvic veins could be restored in 11/12 patients with postoperative significant venous stenoses.

Treatment of Pelvic Venous Spur (May–Thurner Syndrome) with Self-Expanding Metallic Endoprostheses

“…Active treatment is therefore indicated, particularly in young patients with a long life expectancy, to prevent thrombosis and CVI [5]. The implantation of a selfexpanding metallic endoprosthesis is an effective therapy of venous obstruction [4,5] and superior to balloon dilatation alone [14,15]. Venous stenting could obviously produce venous incompetence in some areas by destruction of valves, but this has no relevance in the common iliac vein, which is usually valveless [8].…”

“…Although all stents were well tolerated, the long-term effects are still unknown. The highest risk of recurrence occurs during the first year after stent implantation until a new endothelium has formed in the stents [5,14]. Therefore systemic heparin was administered to all patients for 3 days and overlapping full oral anticoagulation treatment with Acenocoumarol was started on the day of intervention and continued for 6-12 months.…”