Tiefes Venensystem: Hybridverfahren zur Therapie der iliofemoralen chronischen venösen Obstruktionen

Zusammenfassung

Hintergrund Die endovaskuläre Rekanalisation chronischer Verschlüsse der iliofemoralen oder kavalen Venen zeigt vielversprechende Offenheitsraten. Allerdings reduziert sich die Offenheit deutlich, wenn der Verschluss auch die V. femoralis und deren Zuflüsse betrifft. Die Endophlebektomie ermöglicht im Rahmen eines Hybridverfahrens durch Herstellung des Einstroms das Outcome zu verbessern und Frühverschlüsse zu vermeiden. Ziel der Arbeit ist es, die Technik und die bisher veröffentlichten Ergebnisse vorzustellen.

Ergebnisse In dem Hybridverfahren erfolgt die venöse Rekanalisation und eine Endophlebektomie als Kombinationseingriff. Bisher liegen nur 4 Publikation mit mehr als 10 Patienten vor mit einem Follow-up zwischen 6 und 24 Monaten. Die primäre bzw. sekundäre Offenheit variiert zwischen 0 und 77% bzw. 30 und 93%. Allerdings wurde bei der überwiegenden Zahl der Patienten eine Verbesserung der klinischen Symptomatik beschrieben.

Schlussfolgerung Obwohl nur wenige Daten zum Hybridverfahren und zur Endophlebektomie vorliegen, scheint es diese Technik zu ermöglichen, auch venöse Verschlussprozesse, die bis in den femoralen venösen Zufluss reichen, zu behandeln.

Abstract

Background Endovascular recanalisation of chronic obstruction of iliofemoral or caval veins gives very good patency. However, patency decreases if the common femoral vein and its side branches are also involved. Endophlectomy during a hybrid procedure can improve outcome and avoid early reocclusion due to restored inflow. The review presents the technical details and the published results of this technique.

Results The hybrid procedure combines venous recanalisation and stent angioplasty with endophlebectomy. There have only been 4 studies with more than 10 patients and follow-up between 6 and 24 months. Primary and secondary patency ranges from 0 to 70% and 30 to 93%, respectively, but most patients showed clinical benefit.

Conclusion Although there have only been a few studies on the hybrid procedure with endophlebectomy, this technique seems to improve the outcome of venous recanalisation if femoral inflow is disturbed.

Schlüsselwörter

venöse Obstruktion - Endophlebektomie - Rekanalisation - Stentangioplastie

Key words

venous obstruction - endophlebectomy - recanalisation - stent angioplasty

• Literatur

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