Minyi Yin
Nationality
China
Current Position
Chief Physician
Organization
Department of Vascular Surgery, the Ninth People’s Hospital, affiliated to Shanghai Jiao Tong University School of Medicine
Venous Session

Topic: Endovascular debulking in the chronically venous ISR

Abstract

Objective: The study aimed to evaluate the feasibility, safety, and outcome of endovascular debulking of chronically venous in-stent re-obstruction patients (VISR) with moderate to severe symptoms.
Methods: A retrospective review of symptomatic patients with chronic VISR that underwent endovascular debulking of obstructive stent was conducted in our institutions from January 2015 through December 2020. Eighty-seven patients with moderate to severe symptoms were included in the study. Demographics, previous endotreatment, procedural data, technical success, complications, vessel patency and symptom improvement were analyzed.
Results: The reasons for previous venous stent mainly included post-thrombotic syndrome (PTS) (n=61, 70.1%) and Cockett syndrome combined with thrombosis (n=25, 28.7%). The median symptom recurrence period was 16.7 months (range, 3-43months). All patients had moderate (n=62, 71.3%) or severe (n=25, 28.7%) chronic symptoms according to the Villalta score. Technical success of reconsturction was achieved in 71 (81.6%) of 87 limbs. All patients received re interventional therapy based on debulking technology (Rotarex in 33, Turbo elite in 28 and Turbo hawk in 10). Intraoperative complications included 5 vessel perforations (5.7%), 2 access hematomas (2.3%) and 1 acute thrombosis (1.1%). The mean follow-up period was 23.6 months. The primary and secondary patency rates were 73.1% (±0.05 standard error [SE]) and 88.7% (±0.04 SE) at 12 months, 67.0% (±0.06 SE) and 74.2% (±0.05 SE) at 24 months follow up. The Villalta score was significantly improved during follow up (13.82±2.94 vs. 8.75±3.18, p <0.01). seven (9.9%) and 47 (66.2%) patients reached two and one grades relief of Villalta score respectively.
Conclusions: Endovascular debulking of chronic VISR is a safe and feasible procedure, with reasonable technical success, vessel patency and symptom improvement rates. Although technically challenging, this therapeutic option could be highly recommended in chronic VISR patients with moderate to severe symptoms.

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