Alvarado-Acosta L, Román-Hernández R, San Martín-Cerecedo CA

Language: Spanish
References: 16
Page: 98-106
PDF size: 424.66 Kb.

ABSTRACT

Introduction. The iliocaval compression syndrome, also known as Cockett's or May Thurner's syndrome, is an anatomical, compression or endoluminal alteration of the left common iliac vein that causes obstruction, stenosis and/or femoral iliac thrombosis. This is a very frequent clinical situation in patients with venous symptoms of the lower left limb, ranging from the presence of vatical veins, deep venous thrombosis and venous hypertension with or without signs and symptoms of moderate to severe chronic venous insufficiency and associated or not with post-thrombotic sequelae.
Objective. To evaluate and report the results in the short and medium term of the endovascular treatment of chronic obstruction of the iliac vein and joint of the iliocaval sector in 43 patients treated at the Angiology Vascular and Endovascular Surgery Service at the Hospital Central Militar, Mexico City, during the period from September 2015 to September 2016.
Material and methods. A total of 43 patients (46 extremities, 28 women, mean age 46 years, MII/ MID ratio 40/6, 3 bilateral lesions) were retrospectively analyzed, who underwent endovascular surgery in the iliocaval venous system. They had a history of left iliofemoral deep vein thrombosis as well as advanced stages of their chronic venous disease. For the procedure were used self-expanding Stents with endovascular technique. The technical aspects, Stent permeability, pre and post-procedure quality of life, as well as the improvement in the Villalta scale and chronic venous insufficiency severity index (VCSSI) were evaluated for follow-up.
Results. Recanalization was successful in 42 patients (45 limbs, 97.8%) by the use of self-expanding Stents. In 1 case it was not possible to cross the lesion (2.17%). The rate of permeability at the time of discharge was 100% with an average hospital stay 3 days. No major complications of bleeding were reported. The mean follow-up period was 8 months (range 3 to 12 months). The improvement in quality of life on the Villalta Scale at 6 months of follow-up with an average decrease of 7 points in Moderate post-thrombotic syndrome (5 treated cases) and an average decrease of 15 points in Severe post-thrombotic syndrome (37 cases treated). The primary patency rate was 100% at 6 months. During a mean of 8 months (range 3 to 12 months) the rate of improvement of severe pain (4-5 on the analog pain scale) was 100% (with a decrease of 2-3 points in analog pain scale), and severe edema o 97.8%. Eleven patients (24.4%) presented total resolution of pain and 10 patients (22.2%) showed total resolution or the edema, the remaining showed partial resolution. The healing of venous ulcers was successful in 100% of the treated cases.
Conclusions. Iliocaval venous revascularization is a low risk procedure with an acceptable permeability rate. Its main impact is on the patient's quality of life. The proper interpretation of the ultrasonographic study and its correlation with ascending phlebography are an option of easy access and lower cost for the identification of these lesions.

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