This study aimed to evaluate technical and clinical outcomes following endovascular inferior vena cava reconstruction in patients with non-malignant obstruction.
Pre-operative, procedural and follow-up medical records and imaging were retrospectively reviewed in 59 consecutive patients who underwent endovascular inferior vena cava reconstruction for non-malignant obstruction from February 2014 to January 2019. Patients were classified into three groups by quality of their infra-inguinal inflow vessels. Outcomes measured were primary, primary-assisted and secondary patency rates, re-intervention rates and symptomatic resolution.
Indications for treatment were post-thrombotic syndrome (n=41), acute deep vein thrombosis (n=12) and retroperitoneal fibrosis (n=6). Median patient age was 37 years 11 months, 71.2% were male and 32.2% had a diagnosed thrombophilia, with no significant difference in these demographics between the three inflow groups. Median follow-up duration was 2 years 3 months (range 6 months to 6 years 5 months). Whole-cohort primary patency was 91.2%, 71.0% and 24.1% at 1, 3 and 5 years respectively, whilst secondary patency was 76.7% at 1 year and 66.4% at both 3 and 5 years. Inflow group A (no post-thrombotic disease in femoral or deep femoral veins) demonstrated a significantly higher primary patency than group B (stenotic disease in one or two of the infra-inguinal inflow veins) with p=0.009, and a significantly higher secondary patency than both group B (p=0.008) and group C (all three infra-inguinal inflow veins stenosed or femoral and/or deep femoral vein occlusion) with p=0.04. In post-thrombotic syndrome patients Villalta scores reduced from mean 14.2 to 8.1 at 1 year and 6.8 at 2 years, whilst VEINES-QoL/Sym score improved from mean 19.8 to 54.1 and 57.3. In acute deep vein thrombosis patients Villalta score was 2.8 at 1 year and 0 at 2 years. In retroperitoneal fibrosis patients VEINES-QoL/Sym score improved from mean 25.3 at baseline to 44 at 6 months.
Endovascular inferior vena cava reconstruction for non-malignant obstruction can achieve good patency and clinical improvement, although outcomes are poorer in patients with post-thrombotic disease of the femoral and deep femoral veins.

Copyright © 2021. Published by Elsevier Inc.

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