Biomedical subjects
Publications and source records attributed to H Loeprecht.
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Explore the source record for details and available documents.
PURPOSE: To provide follow-up data on endovascular intervention for venous stenoses in the pelvis. METHODS: Between 1985 and 1995, 35 patients presented with 42 stenoses of the pelvic veins after operative thrombectomy and creation of an arteriovenous fistula, combined with intraoperative venous angioscopy. All patients underwent angioplasty and, if unsuccessful, percutaneous insertion of an endovascular stent (n = 7). RESULTS: Angioplasty with and without endovascular stenting was technically successful in 34 of 35 patients (97%). Average length of the stenoses was 20.6 mm (range 10-90 mm), average diameter before dilation 4.1 mm (range 2-6 mm), and average diameter after dilation 10.1 mm (range 5-18 mm). Intraoperative angioscopy showed pathologic findings (intimal laceration or residual thrombotic material) in 14 patients. After an average follow-up period of 4.13 years, 24 (69%) patients had patent veins. The difference in the primary patency rate between patients with angioscopically abnormal veins (6 of 14 patients, corresponding to a patency rate of 43%) and patients with angioscopically normal veins after thrombectomy (18 of 21 patients, corresponding to a patency rate of 86%) was statistically significant (p<0.01, log rank test). CONCLUSIONS: Percutaneous transluminal angioplasty and/or stenting are good treatment modalities for pelvic vein stenosis following surgical thrombectomy. Angioscopically abnormal veins have a poorer long-term patency, regardless of the type of intervention.
From October 1982 to February 1989 148 patients underwent venous thrombectomy. Priority for surgery was given especially in patients under 40 years with posttraumatic, postoperative and postpartum thrombosis where lysis was not possible. Our standardized operative technique includes atraumatic exposure of the vessels, clot extraction by balloon catheter and ring stripper, endoscopic control of the lumen and establishment of a temporary arteriovenous fistula. Postoperative angiography revealed that more than 10% of the patients needed secondary dilatation of iliac vein stenosis which can be carried out easily at the time of closing the fistula. Functional and anatomical parameters as well as the clinical outcome after 12 months show good to excellent results which confirm venous thrombectomy as a useful treatment modality at an acceptable risk level.
Vascular endoscopy, especially of the venous system, allows a tri-dimensional evaluation and represents, to date, the best possible per-operative control of the diameter of the vessel. Under these conditions, venous thrombectomy may be performed more accurately; residual adherent parietal thrombi which may represent a possible source of emboli, may be eliminated. Venous endoscopy may be repeated several times; it does not result in any X-Rays exposure for the patient and enables to diagnose finer morphological details. Therapeutic measures under direct vision could even become possible in the future.