Iliac vein intervention with arteriovenous fistula in treatment of lower extremity postthrombotic syndrome / 中华普通外科杂志

ABSTRACT

Objective To discuss a new method of interventional and surgical therapy for the lower extremity postthrombotic syndrome (PTS). Methods 35 PTS cases were enrolled in our group. Dilation and stent placement in stenosis of iliac veins were performed in all cases, then temporary femoral arteriovenous fistula was established. After two weeks, 15 cases with varicosity underwent high ligation of the great saphenous vein and stripping, 5 cases with leg ulcers (ulcers diameter>3 cm) underwent skingrafting. After operation, patients took warfarin orally for 6 months and wear elastic compression stockings. Results Procedures were successful in all cases. Thrombectomy extracted only a few old thrombus. Before discharge, limb swelling subsided in 26 cases while 4 remain light swelling and 5 had no obviously relief. Twenty-six cases were followed-up for 3～24 monthes. Limb swelling subsided in 22 cases but still exist in 4. Limb ulcers were healed in 11 cases and the area of pigmentation were diminished. Limb ulcer recurred 12 months after skingrafting and healed finaly after perforator veins clipping with second skingrafting. Color Doppler was used in follow-up to check the potency of affected deep veins, good outcome was found in 20 cases and rough intima with stenosis of iliac veins was found in 2, no flow signal in 4. Conclusions Stenosis of iliac veins in PTS are common, the pathological changes could be treated by interveional method combined with temporary arteriovenous fistula. The degree of recanalization of femoral-popliteal veins determined the results.