Long-term outcomes of veno-venous bypass operations in postthrombotic syndrome

BACKGROUND: Surgical reconstructions for venous occlusive disease are rarely performed. Consequently, reliable data on long-term patency, clinical outcome, hemodynamic evaluation and risk factors for graft occlusion are poor. The present study was aimed at assessing long-term results of venovenous bypass operations in postthrombotic syndrome (PTS).

METHODS: We analyzed long-term outcomes of crossover vein bypass procedures in 68 patients with unilateral postthrombotic iliac vein obstructions at periods from two to 28 years and 12 patients who underwent saphenopopliteal bypasses for femoral vein obstructions.

RESULTS: It was validated that the decisive factor of the success of the crossover bypass procedure was a sufficient diameter of venous graft, i.e., not less than 7–8 mm. The advantage of dilated great saphenous vein of affected extremity is shown in this study. It has been determined that in 70.6% of the patients, crossover grafts have a propensity to dilate, furnishing the requisite venous blood outflow from an affected extremity. Venous hemodynamic studies of the affected extremity with occlusion of the external pressed graft revealed that crossover bypass assumes the primary role in the maintenance of venous return. In 15 years, cumulative patency of crossover grafts was 77%. There was cumulative clinical success in 71% of the patients. The patency rate of saphenopopliteal grafting within the period up to 12 years was 91.7%. Long-term outcomes of the procedures proved durable functioning of the grafts and improvement of regional venous hemodynamics. There was significant improvement of reconstructive operations with the usage of distal arteriovenous fistulas.

CONCLUSION: Long-term results demonstrated a high efficacy of venovenous bypass operations in PTS.