Clinical outcomes after direct and indirect surgical venous thrombectomy for inferior vena cava thrombosis

Markus U Wagenhäuser; Christos Dimopoulos; Kamile Antakyali; Yvonne K Meyer-Janiszewski; Joscha Mulorz; Wiebke Ibing; Neslihan Ertas; Joshua M Spin; Hubert Schelzig; Mansur Duran

doi:10.1016/j.jvsv.2018.11.005

Clinical outcomes after direct and indirect surgical venous thrombectomy for inferior vena cava thrombosis

J Vasc Surg Venous Lymphat Disord. 2019 May;7(3):333-343.e2. doi: 10.1016/j.jvsv.2018.11.005. Epub 2019 Mar 8.

Affiliations

¹ Department of Vascular and Endovascular Surgery, Heinrich-Heine University, Düsseldorf, Germany.
² Department of Vascular and Endovascular Surgery, Heinrich-Heine University, Düsseldorf, Germany. Electronic address: christos.dimopoulos@med.uni-duesseldorf.de.
³ Department of Vascular and Endovascular Surgery, Heinrich-Heine University, Düsseldorf, Germany; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif.
⁴ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif.

PMID: 30853561
DOI: 10.1016/j.jvsv.2018.11.005

Abstract

Objective: Inferior vena cava thrombosis is rare, but patients are at high risk for development of a post-thrombotic syndrome (PTS) in the long term. Surgical approaches include indirect transfemoral venous thrombectomy (iTFVT) and direct open venous thrombectomy (dOVT). This study reports patient outcomes after iTFVT and dOVT for inferior vena cava thrombosis covering a 25-year follow-up period.

Methods: The study period was from January 1, 1982, to December 31, 2013. Data were retrieved from archived medical records, and patients were invited for a detailed phlebologic follow-up examination (DPFE). Health-related quality of life was assessed with the 36-Item Short Form Health Survey questionnaire. Patient survival, patency rates, and freedom from PTS were calculated using Kaplan-Meier estimation with log-rank testing. The χ² test with Yates continuity correction and logistic regression analysis were applied to identify associations between risk factors or coagulation disorders, mortality, and PTS.

Results: Complete medical records were available for 152 patients. Patients' 5-year survival was 91% ± 3%, and 5-year primary and secondary patency rates were 80% ± 3% and 94% ± 2%. Freedom from PTS after 25 years was 84% ± 6%. No differences for patient survival, patency rates, or freedom from PTS were identified between iTFVT, dOVT, and a combination of both procedures. Antithrombin III deficiency was the most common coagulation disorder, and patients' physical function and social function were impaired compared with those found in German normative data (P < .05). No risk factor or coagulation disorder was associated with survival or PTS.

Conclusions: Open surgical venous thrombectomy is safe and delivers satisfying short- and long-term outcomes compared with endovascular approaches. It remains valuable for patients who are not eligible for other interventional therapies.

Keywords: Deep venous thrombosis; Iliofemoral; Post-thrombotic syndrome; Surgery.

Publication types

Comparative Study

MeSH terms

Adult
Endovascular Procedures* / adverse effects
Endovascular Procedures* / mortality
Female
Humans
Male
Middle Aged
Postthrombotic Syndrome / etiology
Progression-Free Survival
Quality of Life
Retrospective Studies
Risk Factors
Thrombectomy* / adverse effects
Thrombectomy* / mortality
Time Factors
Vascular Patency
Vena Cava, Inferior / physiopathology
Vena Cava, Inferior / surgery*
Venous Thrombosis / complications
Venous Thrombosis / mortality
Venous Thrombosis / physiopathology
Venous Thrombosis / surgery*