Department of Vascular and Endovascular Surgery, Heinrich-Heine University, Düsseldorf, Germany.
Department of Vascular and Endovascular Surgery, Heinrich-Heine University, Düsseldorf, Germany.
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.
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.
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 χ test with Yates continuity correction and logistic regression analysis were applied to identify associations between risk factors or coagulation disorders, mortality, and PTS.
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.
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.
下腔静脉血栓形成较为罕见，但患者在长期内有发生血栓后综合征（PTS）的高风险。手术方法包括间接经股静脉血栓切除术（iTFVT）和直接开放静脉血栓切除术（dOVT）。本研究报告了 25 年随访期间 iTFVT 和 dOVT 治疗下腔静脉血栓形成的患者结局。
研究期间为 1982 年 1 月 1 日至 2013 年 12 月 31 日。数据从存档的病历中检索，并邀请患者进行详细的静脉疾病随访检查（DPFE）。使用 36 项简短健康调查问卷评估健康相关生活质量。使用 Kaplan-Meier 估计和对数秩检验计算患者生存率、通畅率和无 PTS 率。应用卡方检验（Yates 连续性校正）和逻辑回归分析来确定危险因素或凝血障碍、死亡率和 PTS 之间的关联。
152 例患者的完整病历可用。患者的 5 年生存率为 91%±3%，5 年原发和继发通畅率分别为 80%±3%和 94%±2%。25 年后无 PTS 的比例为 84%±6%。iTFVT、dOVT 和两种手术联合治疗之间在患者生存率、通畅率或无 PTS 率方面没有差异。抗凝血酶 III 缺乏是最常见的凝血障碍，与德国参考数据相比，患者的身体功能和社会功能受损（P<.05）。没有任何危险因素或凝血障碍与生存率或 PTS 相关。
与血管内方法相比，开放手术静脉血栓切除术是安全的，可提供令人满意的短期和长期结果。对于不适合其他介入治疗的患者，它仍然具有价值。
