- Email: [email protected]
Endovenous Laser Therapy (ELT) Of Saphenous Vein Reflux Using Thulium Laser (Tm, 1940 nm) with Radial Fiber – One Year Results
Abstracts
413
rate within the first year from 30% to 10% of the patient population. A secondary objective is a non-inferiority of MonoMax suture material (group C) in comparison to MonoPlus (group A). Results: 108 patients were randomized between February 2011 and July 2013. The compare of demographic data, risk factors and co-morbidities did not reveal structural differences between the study groups. After 12 months 4.55% of the patients with an additional implanted mesh in onlay position (group B) had developed an incision hernia versus 21.74% undergoing midline closure using two monofilaments suture loops (group A). In group C 18.18% of patients with 12-months-follow-up had an incision hernia. Non-parametric binomial testing assuming a hernia rate of 20% or 30% after 12 months was performed. For group A and C, herniation significantly differing from 20% (p ¼ 0.499 respectively p ¼ 0.543) or 30% (p ¼ 0.269 respectively p ¼ 0.165) could be refused, while the number of hernias in group B significantly differed from 20% (p ¼ 0.048) and 30% (p ¼ 0.004). Wound healing disorders occurred in15.19%. Notable differences were visible in formation of seromas which were exclusively found in patients of group B (19.23%) but not in group A or C. In total, re-surgery of the abdominal wall was performed in n ¼ 11 patients (10.68%). This number also includes n ¼ 4 non-emergency interventions (revision of the abdominal wall because of persistent seroma or repair of incision hernia). Conclusion: Additional mesh in onlay position after median laparotomy for AAA can reduce hernia rate significantly. Disclosure of Interest: None Declared.
ESVS2016-1455
SESSION 9 e VENOUS/WOUND FRI, 30 SEPT, 08:00e9:00
Endovenous Laser Therapy (ELT) Of Saphenous Vein Reflux Using Thulium Laser (Tm, 1940 nm) with Radial Fiber e One Year Results
ESVS2016-1618 A Systematic Review of Stenting in the Management of Acute Deep Venous Thrombosis M.A.H. Taha
1,*
1
Primary, assisted primary and secondary patency rates 12 months after stent placement were 85.80%, 87.06% and 91.61%, respectively. PTS was assessed in most studies, although recognised tools were only employed in 18 studies (Villalta; 9, Modified Villalta; 1, VCSS; 1 and CEAP; 7). With the overall PTS rate 8.3% of patients in studies that reported PTS as an outcome measure. The incidence of stent re-thrombosis (both early and late) ranged from 5% to 25%. In 98% of the included studies, anticoagulation was administered to all patients who underwent venous stenting and, in 16% of studies, patients received additional antiplatelet therapy consisting of aspirin and/or clopidogrel. The duration of anticoagulation treatment was not guided by the stenting procedure in 75% of studies but guided by the pre-existing predisposing factors 95%. Quality of life questionnaires employed in 22% of included studies and a RCT identified an improvement in VCSS (7.57 0.27 vs. 0.69 0.23) and CIVIQ (22.67 3.01 vs. 39.34 6.66) between both test and control groups, which a high statistical significance for the difference in VCSS and CIVIQ in control and treatment groups (p < 0.001). Conclusion: Venous stenting for an acute DVT of the lower extremity appears to be an effective endovascular option with a high patency rate up to 1 year as well as reducing the incidence of post-thrombotic syndrome and recurrent DVTs. Further studies with longer-term follow-up would allow for a better assessment of this technique and to determine the optimal length of anticoagulation therapy after stent placement and the impact on quality of life. Disclosure of Interest: None Declared.
1
, A. Busuttil , R. Bootun , A.H. Davies
2
1
Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom 2 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, United Kingdom
Introduction: Deep venous thrombosis (DVT) involving the ilio-femoral vein is associated with significant morbidity. Percutaneous endovascular interventions (PEVI) for acute DVT allow for detailed examination of the vein segment in question following thrombus resolution and in most cases unmasks the causative lesion. Treating iliac vein stenosis/compression with venous stenting is thought to reduce the recurrence rate of DVT as well as reduces the severity of symptoms of post thrombotic syndrome (PTS). The aim of this review is to evaluate the impact of venous stenting on the presence of chronic venous insufficiency symptoms, recurrence of thrombosis and stent patency and the optimal duration of anticoagulation following stent placement. Methods: Embase and Medline databases (from 1949 to Feb 2016) were interrogated to identify studies looking at stenting in patients with acute ilio-femoral DVT. Additional references were manually added from reviews and opinion articles included in our initial search. The extracted data was tabulated and descriptive statistics were performed using Excel (Microsoft, Redmond, WA). The inclusion criteria were: (1) Randomised controlled studies for acute venous stenting (2) Case series that included more than 5 stenting patients in their series (3) Lower limb venous stenting (4) Studies published in English (5) Human studies. Results: Seven hundred and eighty-one articles were initially identified from database search. Additional references were obtained by manually checking reviews and original investigations. Following title and abstract screening, 49 articles were included. The 49 studies included 843 patients (850 limbs) stented acutely. Only patients who were stented during the thrombolytic procedure were included in the analysis for stent patency.
C.-G. Schmedt 1,2, A. Esipova 1,*, S. Dikic 1, A. Setia 1, S. Demhasaj 1, T. Dieckmann 1, M.-M. Tipi 1, R. Sroka 2 1
Department for Vascular Surgery, Diakonie-Klinikum Schwaebisch Hall, Schwaebisch Hall, Germany 2 Laser Research Laboratory, LIFE Centre, Ludwig-Maximilians-University, Munich, Germany
Introduction: The use of endovenous laser therapy (ELT) with longer wavelengths (e.g. 1470 nm) is indicated to be advantageous over ELT with shorter wavelengths (e.g. 810e980 nm). The 1940 nm Thulium-Laser is claimed to target and heat water (as opposed to hemoglobin) in the bloodstream. In this clinical study the one-year results of the ELT application of 1940 nm laser with respect to feasibility, effectiveness and safety are reported. Methods: In this single center, prospective observational study, 138 patients with saphenous reflux (great saphenous vein e GSV and small saphenous vein e SSV) were treated with 1940 nm laser (radial fiber) with continuous pullback (1 mm/s). The choice of anesthesia was general, spinal or only tumescent. The tumescent anesthesia was infiltrated in all cases perivenous in the saphenous sheath under ultrasound guidance (USG). Simultaneous miniphlebectomy was performed in all cases additionally ligation of insufficient perforators were performed in selected patients. Clinical evaluation by means of color duplex sonography, clinical examination, standardized questionnaire and pro-forma was done preoperatively and postoperatively after 3 days, 4 weeks, 6 months and 12 months. The data was collected and tabulated with respect to demographics, vein morphology, longitudinal endovenous energy density (LEED), postoperative pain intensity, analgesia requirement, resumption of daily activities and persistent reflux. Results: A total of 138 patients corresponding to 177 saphenous veins were operated (female/male ratio 107/70, mean age 55 years, range 23e 90 years). The 3 day and 4 week follow up rate was 100%. 135 (76.3%) saphenous veins were followed up at 12 months. The mean preoperative maximum diameter of the GSV was 6.9 mm (range 3.3e11.3 mm) and of the SSV was 5.1 mm (range 2.6e10.0 mm). The mean LEED applied was 59.2 Joules/cm (range 30.0e98.2 J/cm) for GSV and 47.3 J/cm (range 30e
414 70 J/cm) for SSV. The complete occlusion of the treated saphenous vein was defined as absence of flow on color Doppler imaging and was achieved in 174/177 (98.3%) subjects at 4 weeks and 132/135 (97.7) patients at 12 months. Partial occlusion was observed in three patients and was defined as reflux >3 cm distal to the junction. The mean length of non-occluded stump at the junction between saphenous vein and deep vein was 0.5 cm (range 3.6 to 5.0 cm) 4 weeks postoperative. Mean postoperative reduction of the diameter of GSV and SSV at 1 year was 40% and 56% respectively (p < 0.05%). In the early postoperative phase paraesthesia was observed in 15/177 (8.5%), ecchymosis in 4/177 (2.3%), lymphocoele in 1/ 177 (0.6%), hyperpigmentation in 1/177 (0.6%). Endovenous heat induced thrombus (EHIT) propagation was observed in 4/177 (2.3%) subjects. There were no skin burns or phlebitis. No patient reported severe pain. The mean postoperative pain intensity (Visual Analog Scale) was 1.3. The mean convalescence period was 2 days (1e30 d). No long-term complications and recurrent reflux was observed at 1 year follow-up. Conclusion: ELT using Thulium laser (1940 nm) with radial fiber efficiently eliminates the reflux in the saphenous veins by occlusion and significant diameter reduction with no reflux recurrence at 1 year follow up. The complication rates are less or comparable to the other endothermal and surgical procedures. These benefits are offered with low postoperative pain, analgesia requirement and rapid convalescence.
ESVS2016-1292 Endovascular Recanalization of Chronic Non-malignant Obstruction of the Inferior Vena Cava
Abstracts Results: Recanalization with stenting of the IVC was technically successful in 19/20 patients. There were no major complications. One patient with PTS died of unrelated causes after 3 months. At final follow-up 15/19 (78%) had open IVC stents. The 24 months primary patency was 8/12 (67%) and secondary patency was 10/12 (83%). One of four with stent occlusion experienced worsening of symptoms compared to baseline. During follow-up reintervention were performed in four patients. VCSS improved in 9 patients with PTS symptoms, was unchanged in 4 and worse in one. Median VCSS preoperatively was 8.5 (range 3e25). At final follow-up median VCSS was 7 (range 2e23). 5/9 reported cessation of venous claudication at final followup. Among the four patients with a suspected reduced cardiac preload there were no episodes of syncope during follow-up. Three reported unrestrained physical activity, and one improved physical performance. In total 13 of 19 patients experienced sustained clinical improvement. Conclusion: Endovascular recanalization of chronic IVC obstruction is technically feasible, safe and leads to substantial clinical improvement. Disclosure of Interest: None Declared.
ESVS2016-1690 “To Cover or Not To Cover, That Is the Question”; Rectus Femoris Muscle Flaps in Groin Defects after Vascular Surgery J. Conings 1,2,3,4,*, J.W. Daemen 1, I. Mostaert 2, J.-W. Elshof 2, M. Scheltinga 3, B. Mees 4 1
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway 2 Oslo Vascular Centre, Oslo University Hospital, Norway 3 Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands 2 Department of Vascular Surgery, Viecuri Hospital, Venlo, Netherlands 3 Department of Vascular Surgery, Maxima Medical Center, Veldhoven, Netherlands 4 Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, Maastricht, Netherlands
Introduction: Chronic obstruction of the inferior vena cava (IVC) may result from previous thrombosis or congenitalanomaly. The clinical presentation of an IVC obstruction is either symptoms of post thrombotic syndrome (PTS) or related to a reduced cardiac preload. PTS patients have traditionally been conservatively treated with anticoagulation and compression stockings. More aggressive approaches for IVC obstruction have been reported including surgical reconstruction and endovascular recanalization with stents. For both approaches there is so far little documentation. We report our experience with endovascular recanalization with stenting of the IVC. Methods: A retrospective study of patients with IVC obstruction verified with CT- and/or MRI venography and accepted for endovascular recanalization at Oslo University Hospital Aker during 2010e2015. Patients with PTS were categorised according to the CEAP classification. Symptom severity was assessed using the venous clinical severity score (VCSS). Twenty patients were accepted for IVC stenting; median age 43 (range 15e63) years, nine were women. Median follow-up was 25 (3e70) months. Sixteen patients presented with post-thrombotic symptoms of the leg including venous claudication, oedema, recurrent deep venous thrombosis (DVT), or leg ulcer(s). Seven patients were in CEAP category C3, two in C4, one in C5 and six were C6. Venous claudication was the main treatment indication for C3e4. Four patients had a history of dyspnoea and episodes of syncope during physical activity, but no PTS symptoms. The endovascular procedure was performed in a hybrid angiosuite under general anaesthesia and full anticoagulation. Ultrasound guided access through the right internal jugular vein and femoral veins. After passing the obstruction, self-expanding, large diameter WallstentsÒ (18e24 mm) were placed, gaining outflow at the intrahepatic IVC. The iliac confluens was reconstructed in 16 patients. Inflow was obtained from the iliacs in six patients and from the femoral level in ten. Large diameter balloons were used for pre- and postdilatation. Follow-up was performed at 3, 6, 12, 18 months, and yearly thereafter included clinical evaluation and colour duplex ultrasound (CDU).
Introduction: Vascular surgery complications in the groin can lead to significant soft tissue defects and serious life threatening infections and are therefore challenging for surgeons. Worldwide the sartorius flap is the most used and described technique for coverage of groin defects. The rectus femoris flap is an alternative technique to cover these defects without any tension. For this technique, a distal incision is made on the upper leg in the musculus rectus femoris to detach the muscle, tunnel it subcutaneously and cover the groin. The aim of this study was to evaluate the results of the rectus femoris flap as a tool in treating groin defects. Methods: In the Netherlands, data was collected in three centers of all patients undergoing rectus femoris flap coverage of groin defects between 2000 and 2015. In total, 77 groin defects were treated in 70 patients. Outcomes were defined as clinical success (recovery and hospital discharge without major bleeding, sepsis or amputation), survival, 30-day complication rate and reintervention after the index operation of the rectus femoris flap. Results: Indications for rectus femoris muscle flap coverage of groin defect were hematoma or bleeding, blow-out, false aneurysm, wound infection, infected non-human implant, and re-do bypass surgery. Initial procedures included a large variety of bypasses and endovascular procedures. The average number of previous operations in the groin of interest was 2.1 (range 1e6). Clinical success was 76% (53/70 patients). A total of 17 patients died because of sepsis (n ¼ 8), postoperative unsuccessful reanimation (n ¼ 1), massive bleeding (n ¼ 1), heart failure (n ¼ 1) and other causes than vascular or flap related (n ¼ 6). No amputations were described. A total of 23 groin complications was seen after rectus femoris flap coverage including infection (n ¼ 8), graft loss (n ¼ 15), bleeding (n ¼ 6), blow-out (n ¼ 2) and necrosis of the muscle flap (n ¼ 1). In 1 patient there was a donor site complication due to bleeding. Conclusion: This is the largest European series of rectus femoris flaps for vascular surgery groin complications and demonstrates that this technique is an effective treatment for coverage of large groin defects. The outcomes confirm the significant morbidity and mortality of this patient group. Disclosure of Interest: None Declared.
O.J. Grøtta 1,*, T. Enden 1, G. Sandbæk 1, D. Bay 1, C.-E. Slagsvold 2, G.F. Gjerdalen 2, J.J. Jørgensen 3, A. Rosale 3 1
413
rate within the first year from 30% to 10% of the patient population. A secondary objective is a non-inferiority of MonoMax suture material (group C) in comparison to MonoPlus (group A). Results: 108 patients were randomized between February 2011 and July 2013. The compare of demographic data, risk factors and co-morbidities did not reveal structural differences between the study groups. After 12 months 4.55% of the patients with an additional implanted mesh in onlay position (group B) had developed an incision hernia versus 21.74% undergoing midline closure using two monofilaments suture loops (group A). In group C 18.18% of patients with 12-months-follow-up had an incision hernia. Non-parametric binomial testing assuming a hernia rate of 20% or 30% after 12 months was performed. For group A and C, herniation significantly differing from 20% (p ¼ 0.499 respectively p ¼ 0.543) or 30% (p ¼ 0.269 respectively p ¼ 0.165) could be refused, while the number of hernias in group B significantly differed from 20% (p ¼ 0.048) and 30% (p ¼ 0.004). Wound healing disorders occurred in15.19%. Notable differences were visible in formation of seromas which were exclusively found in patients of group B (19.23%) but not in group A or C. In total, re-surgery of the abdominal wall was performed in n ¼ 11 patients (10.68%). This number also includes n ¼ 4 non-emergency interventions (revision of the abdominal wall because of persistent seroma or repair of incision hernia). Conclusion: Additional mesh in onlay position after median laparotomy for AAA can reduce hernia rate significantly. Disclosure of Interest: None Declared.
ESVS2016-1455
SESSION 9 e VENOUS/WOUND FRI, 30 SEPT, 08:00e9:00
Endovenous Laser Therapy (ELT) Of Saphenous Vein Reflux Using Thulium Laser (Tm, 1940 nm) with Radial Fiber e One Year Results
ESVS2016-1618 A Systematic Review of Stenting in the Management of Acute Deep Venous Thrombosis M.A.H. Taha
1,*
1
Primary, assisted primary and secondary patency rates 12 months after stent placement were 85.80%, 87.06% and 91.61%, respectively. PTS was assessed in most studies, although recognised tools were only employed in 18 studies (Villalta; 9, Modified Villalta; 1, VCSS; 1 and CEAP; 7). With the overall PTS rate 8.3% of patients in studies that reported PTS as an outcome measure. The incidence of stent re-thrombosis (both early and late) ranged from 5% to 25%. In 98% of the included studies, anticoagulation was administered to all patients who underwent venous stenting and, in 16% of studies, patients received additional antiplatelet therapy consisting of aspirin and/or clopidogrel. The duration of anticoagulation treatment was not guided by the stenting procedure in 75% of studies but guided by the pre-existing predisposing factors 95%. Quality of life questionnaires employed in 22% of included studies and a RCT identified an improvement in VCSS (7.57 0.27 vs. 0.69 0.23) and CIVIQ (22.67 3.01 vs. 39.34 6.66) between both test and control groups, which a high statistical significance for the difference in VCSS and CIVIQ in control and treatment groups (p < 0.001). Conclusion: Venous stenting for an acute DVT of the lower extremity appears to be an effective endovascular option with a high patency rate up to 1 year as well as reducing the incidence of post-thrombotic syndrome and recurrent DVTs. Further studies with longer-term follow-up would allow for a better assessment of this technique and to determine the optimal length of anticoagulation therapy after stent placement and the impact on quality of life. Disclosure of Interest: None Declared.
1
, A. Busuttil , R. Bootun , A.H. Davies
2
1
Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom 2 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, United Kingdom
Introduction: Deep venous thrombosis (DVT) involving the ilio-femoral vein is associated with significant morbidity. Percutaneous endovascular interventions (PEVI) for acute DVT allow for detailed examination of the vein segment in question following thrombus resolution and in most cases unmasks the causative lesion. Treating iliac vein stenosis/compression with venous stenting is thought to reduce the recurrence rate of DVT as well as reduces the severity of symptoms of post thrombotic syndrome (PTS). The aim of this review is to evaluate the impact of venous stenting on the presence of chronic venous insufficiency symptoms, recurrence of thrombosis and stent patency and the optimal duration of anticoagulation following stent placement. Methods: Embase and Medline databases (from 1949 to Feb 2016) were interrogated to identify studies looking at stenting in patients with acute ilio-femoral DVT. Additional references were manually added from reviews and opinion articles included in our initial search. The extracted data was tabulated and descriptive statistics were performed using Excel (Microsoft, Redmond, WA). The inclusion criteria were: (1) Randomised controlled studies for acute venous stenting (2) Case series that included more than 5 stenting patients in their series (3) Lower limb venous stenting (4) Studies published in English (5) Human studies. Results: Seven hundred and eighty-one articles were initially identified from database search. Additional references were obtained by manually checking reviews and original investigations. Following title and abstract screening, 49 articles were included. The 49 studies included 843 patients (850 limbs) stented acutely. Only patients who were stented during the thrombolytic procedure were included in the analysis for stent patency.
C.-G. Schmedt 1,2, A. Esipova 1,*, S. Dikic 1, A. Setia 1, S. Demhasaj 1, T. Dieckmann 1, M.-M. Tipi 1, R. Sroka 2 1
Department for Vascular Surgery, Diakonie-Klinikum Schwaebisch Hall, Schwaebisch Hall, Germany 2 Laser Research Laboratory, LIFE Centre, Ludwig-Maximilians-University, Munich, Germany
Introduction: The use of endovenous laser therapy (ELT) with longer wavelengths (e.g. 1470 nm) is indicated to be advantageous over ELT with shorter wavelengths (e.g. 810e980 nm). The 1940 nm Thulium-Laser is claimed to target and heat water (as opposed to hemoglobin) in the bloodstream. In this clinical study the one-year results of the ELT application of 1940 nm laser with respect to feasibility, effectiveness and safety are reported. Methods: In this single center, prospective observational study, 138 patients with saphenous reflux (great saphenous vein e GSV and small saphenous vein e SSV) were treated with 1940 nm laser (radial fiber) with continuous pullback (1 mm/s). The choice of anesthesia was general, spinal or only tumescent. The tumescent anesthesia was infiltrated in all cases perivenous in the saphenous sheath under ultrasound guidance (USG). Simultaneous miniphlebectomy was performed in all cases additionally ligation of insufficient perforators were performed in selected patients. Clinical evaluation by means of color duplex sonography, clinical examination, standardized questionnaire and pro-forma was done preoperatively and postoperatively after 3 days, 4 weeks, 6 months and 12 months. The data was collected and tabulated with respect to demographics, vein morphology, longitudinal endovenous energy density (LEED), postoperative pain intensity, analgesia requirement, resumption of daily activities and persistent reflux. Results: A total of 138 patients corresponding to 177 saphenous veins were operated (female/male ratio 107/70, mean age 55 years, range 23e 90 years). The 3 day and 4 week follow up rate was 100%. 135 (76.3%) saphenous veins were followed up at 12 months. The mean preoperative maximum diameter of the GSV was 6.9 mm (range 3.3e11.3 mm) and of the SSV was 5.1 mm (range 2.6e10.0 mm). The mean LEED applied was 59.2 Joules/cm (range 30.0e98.2 J/cm) for GSV and 47.3 J/cm (range 30e
414 70 J/cm) for SSV. The complete occlusion of the treated saphenous vein was defined as absence of flow on color Doppler imaging and was achieved in 174/177 (98.3%) subjects at 4 weeks and 132/135 (97.7) patients at 12 months. Partial occlusion was observed in three patients and was defined as reflux >3 cm distal to the junction. The mean length of non-occluded stump at the junction between saphenous vein and deep vein was 0.5 cm (range 3.6 to 5.0 cm) 4 weeks postoperative. Mean postoperative reduction of the diameter of GSV and SSV at 1 year was 40% and 56% respectively (p < 0.05%). In the early postoperative phase paraesthesia was observed in 15/177 (8.5%), ecchymosis in 4/177 (2.3%), lymphocoele in 1/ 177 (0.6%), hyperpigmentation in 1/177 (0.6%). Endovenous heat induced thrombus (EHIT) propagation was observed in 4/177 (2.3%) subjects. There were no skin burns or phlebitis. No patient reported severe pain. The mean postoperative pain intensity (Visual Analog Scale) was 1.3. The mean convalescence period was 2 days (1e30 d). No long-term complications and recurrent reflux was observed at 1 year follow-up. Conclusion: ELT using Thulium laser (1940 nm) with radial fiber efficiently eliminates the reflux in the saphenous veins by occlusion and significant diameter reduction with no reflux recurrence at 1 year follow up. The complication rates are less or comparable to the other endothermal and surgical procedures. These benefits are offered with low postoperative pain, analgesia requirement and rapid convalescence.
ESVS2016-1292 Endovascular Recanalization of Chronic Non-malignant Obstruction of the Inferior Vena Cava
Abstracts Results: Recanalization with stenting of the IVC was technically successful in 19/20 patients. There were no major complications. One patient with PTS died of unrelated causes after 3 months. At final follow-up 15/19 (78%) had open IVC stents. The 24 months primary patency was 8/12 (67%) and secondary patency was 10/12 (83%). One of four with stent occlusion experienced worsening of symptoms compared to baseline. During follow-up reintervention were performed in four patients. VCSS improved in 9 patients with PTS symptoms, was unchanged in 4 and worse in one. Median VCSS preoperatively was 8.5 (range 3e25). At final follow-up median VCSS was 7 (range 2e23). 5/9 reported cessation of venous claudication at final followup. Among the four patients with a suspected reduced cardiac preload there were no episodes of syncope during follow-up. Three reported unrestrained physical activity, and one improved physical performance. In total 13 of 19 patients experienced sustained clinical improvement. Conclusion: Endovascular recanalization of chronic IVC obstruction is technically feasible, safe and leads to substantial clinical improvement. Disclosure of Interest: None Declared.
ESVS2016-1690 “To Cover or Not To Cover, That Is the Question”; Rectus Femoris Muscle Flaps in Groin Defects after Vascular Surgery J. Conings 1,2,3,4,*, J.W. Daemen 1, I. Mostaert 2, J.-W. Elshof 2, M. Scheltinga 3, B. Mees 4 1
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway 2 Oslo Vascular Centre, Oslo University Hospital, Norway 3 Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands 2 Department of Vascular Surgery, Viecuri Hospital, Venlo, Netherlands 3 Department of Vascular Surgery, Maxima Medical Center, Veldhoven, Netherlands 4 Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, Maastricht, Netherlands
Introduction: Chronic obstruction of the inferior vena cava (IVC) may result from previous thrombosis or congenitalanomaly. The clinical presentation of an IVC obstruction is either symptoms of post thrombotic syndrome (PTS) or related to a reduced cardiac preload. PTS patients have traditionally been conservatively treated with anticoagulation and compression stockings. More aggressive approaches for IVC obstruction have been reported including surgical reconstruction and endovascular recanalization with stents. For both approaches there is so far little documentation. We report our experience with endovascular recanalization with stenting of the IVC. Methods: A retrospective study of patients with IVC obstruction verified with CT- and/or MRI venography and accepted for endovascular recanalization at Oslo University Hospital Aker during 2010e2015. Patients with PTS were categorised according to the CEAP classification. Symptom severity was assessed using the venous clinical severity score (VCSS). Twenty patients were accepted for IVC stenting; median age 43 (range 15e63) years, nine were women. Median follow-up was 25 (3e70) months. Sixteen patients presented with post-thrombotic symptoms of the leg including venous claudication, oedema, recurrent deep venous thrombosis (DVT), or leg ulcer(s). Seven patients were in CEAP category C3, two in C4, one in C5 and six were C6. Venous claudication was the main treatment indication for C3e4. Four patients had a history of dyspnoea and episodes of syncope during physical activity, but no PTS symptoms. The endovascular procedure was performed in a hybrid angiosuite under general anaesthesia and full anticoagulation. Ultrasound guided access through the right internal jugular vein and femoral veins. After passing the obstruction, self-expanding, large diameter WallstentsÒ (18e24 mm) were placed, gaining outflow at the intrahepatic IVC. The iliac confluens was reconstructed in 16 patients. Inflow was obtained from the iliacs in six patients and from the femoral level in ten. Large diameter balloons were used for pre- and postdilatation. Follow-up was performed at 3, 6, 12, 18 months, and yearly thereafter included clinical evaluation and colour duplex ultrasound (CDU).
Introduction: Vascular surgery complications in the groin can lead to significant soft tissue defects and serious life threatening infections and are therefore challenging for surgeons. Worldwide the sartorius flap is the most used and described technique for coverage of groin defects. The rectus femoris flap is an alternative technique to cover these defects without any tension. For this technique, a distal incision is made on the upper leg in the musculus rectus femoris to detach the muscle, tunnel it subcutaneously and cover the groin. The aim of this study was to evaluate the results of the rectus femoris flap as a tool in treating groin defects. Methods: In the Netherlands, data was collected in three centers of all patients undergoing rectus femoris flap coverage of groin defects between 2000 and 2015. In total, 77 groin defects were treated in 70 patients. Outcomes were defined as clinical success (recovery and hospital discharge without major bleeding, sepsis or amputation), survival, 30-day complication rate and reintervention after the index operation of the rectus femoris flap. Results: Indications for rectus femoris muscle flap coverage of groin defect were hematoma or bleeding, blow-out, false aneurysm, wound infection, infected non-human implant, and re-do bypass surgery. Initial procedures included a large variety of bypasses and endovascular procedures. The average number of previous operations in the groin of interest was 2.1 (range 1e6). Clinical success was 76% (53/70 patients). A total of 17 patients died because of sepsis (n ¼ 8), postoperative unsuccessful reanimation (n ¼ 1), massive bleeding (n ¼ 1), heart failure (n ¼ 1) and other causes than vascular or flap related (n ¼ 6). No amputations were described. A total of 23 groin complications was seen after rectus femoris flap coverage including infection (n ¼ 8), graft loss (n ¼ 15), bleeding (n ¼ 6), blow-out (n ¼ 2) and necrosis of the muscle flap (n ¼ 1). In 1 patient there was a donor site complication due to bleeding. Conclusion: This is the largest European series of rectus femoris flaps for vascular surgery groin complications and demonstrates that this technique is an effective treatment for coverage of large groin defects. The outcomes confirm the significant morbidity and mortality of this patient group. Disclosure of Interest: None Declared.
O.J. Grøtta 1,*, T. Enden 1, G. Sandbæk 1, D. Bay 1, C.-E. Slagsvold 2, G.F. Gjerdalen 2, J.J. Jørgensen 3, A. Rosale 3 1