A CASE OF ENDOVENECTOMY AND STENTING WITH A FUNCTIONING ARTERIOVENOUS FISTULA IN EXTENDED POSTTHROMBOTIC OCCLUSION OF DEEP VEINS

The article describes a case of surgical treatment of a 32-year-old female patient with multilevel postthrombotic deep vein occlusion of the left lower limb. The laboratory tests of the patient revealed high-risk hereditary thrombophilia (homozygous mutation PAI-l, MTR, heterozygous mutation MTHFR, MTRR, ITGA2). Endovenectomy from the common femoral vein with the placement of an arteriovenous fistula between femoral vessels was performed as the first stage. The attempt of endovascular stenting of the iliac veins was initially unsuccessful. The patient was hospitalized again 3 months later and successfully underwent endovascular surgery with stenting of iliac veins and common femoral vein with a functioning arteriovenous fistula. The clinical outcome of the surgery was good. Control ultrasound examinations (ultrasound duplex scanning) were performed at 3, 6, 10, and 13 months after the second surgery. According to the data of ultrasound duplex scanning after 13 months the stented segments of deep veins were not obstructed, the arteriovenous fistula functioned well. There were no signs of central hemodynamic abnormalities. There was a significant regression of clinical symptoms. The Villalta score decreased from 13 to 5 in comparison with the initial one. Taking into account the nature of deep vein lesions, the complexity of open and endovascular surgery and the presence of thrombophilia, it was decided to refrain from arteriovenous fistula dissection. This observation demonstrates the possibility, efficiency and safety of long-term functioning of artificial arteriovenous fistula in a certain cohort of patients.