Medium-term Outcomes Following Inferior Vena Cava Reconstruction for Acute and Chronic Deep Vein Thrombosis and Retroperitoneal Fibrosis.

Abstract

OBJECTIVE\nThis study aimed to evaluate technical and clinical outcomes following endovascular inferior vena cava reconstruction in patients with non-malignant obstruction.\n\n\nMETHODS\nPre-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.\n\n\nRESULTS\nIndications 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.\n\n\nCONCLUSIONS\nEndovascular 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.