Venous bypass for iliofemoral venous occlusion: a possible answer for patients with no endovascular solution
DOI:
https://doi.org/10.48750/acv.495Keywords:
iliocaval venous obstruction, post-thrombotic syndrome, venous bypass, iliocaval reconstructionAbstract
INTRODUCTION: Percutaneous endovenous treatment is the first-line therapy for chronic nonmalignant iliocaval venous obstruction (ICVO) due to low morbidity and suitable medium and long-term results. Open surgical procedures are only used as a last resort therapy. However, there is a lack of updated data regarding surgical techniques and outcomes.
We present two cases of surgical venous reconstructions to treat ICVO using expanded polytetrafluoroethylene (ePTFE) grafts and discuss the evidence regarding technical aspects to improve long-term patency.
CASE REPORTS: The first case concerns a 69-year-old male with chronic edema and venous ulceration associated with ICVO secondary to iliocaval stent thrombosis. After an unsuccessful endovascular treatment attempt, we performed a surgical iliocaval bypass using a 10mm ringed ePTFE graft. After three months, complete ulcer healing was observed. The other patient was a 63-year-old female with disabling chronic edema of the right lower limb and venous claudication consequent to the ligation of the right common femoral vein to correct an iatrogenic vascular injury during orthopedic surgery. The patient underwent venous bypass between the deep femoral vein and the ipsilateral common iliac vein using a 12mm ringed ePTFE graft. A marked improvement in clinical symptoms was observed after treatment. A venous stent was used later to treat an anastomotic stenosis.
CONCLUSION: Our experience supports open venous reconstruction as a viable option for patients with benign ICVO and debilitating symptoms not amenable to endovascular treatment. Important technical aspects such as adequate inflow vein, the choice of the prosthetic graft, long-term anticoagulation, and the creation of a distal arteriovenous fistula should be considered to improve patency.
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References
Henke PK, Comerota AJ. An update on etiology, prevention, and therapy of postthrombotic syndrome. J Vasc Surg 2011; 53(2): 500-9.
Razavi MK, Jaff MR, Miller LE. Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction: Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2015; 8(10): e002772.
Jost CJ, Gloviczki P, Cherry KJ, Jr., et al. Surgical reconstruction of iliofemoral veins and the inferior vena cava for nonmalignant occlusive disease. J Vasc Surg 2001; 33(2): 320-7; discussion 7-8.
Garg N, Gloviczki P, Karimi KM, et al. Factors affecting outcome of open and hybrid reconstructions for nonmalignant obstruction of iliofemoral veins and inferior vena cava. J Vasc Surg 2011; 53(2): 383-93.
Nooromid M, De Martino R, Squizzato F, et al. Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: A multicenter experience. J Vasc Surg Venous Lymphat Disord 2022; 10(3): 617-25.
Gloviczki P, Pairolero PC, Toomey BJ, et al. Reconstruction of large veins for nonmalignant venous occlusive disease. J Vasc Surg 1992; 16(5): 750-61.
Husni EA. Reconstruction of veins: the need for objectivity. J Cardiovasc Surg (Torino) 1983; 24(5): 525-8.
Menawat SS, Gloviczki P, Mozes G, Whitley D, Anding WJ, Serry RD. Effect of a femoral arteriovenous fistula on lower extremity venous hemodynamics after femorocaval reconstruction. J Vasc Surg 1996; 24(5): 793-9.
Anaya-Ayala JE, Adams MK, Telich-Tarriba JE, Dresser KL, Ismail N, Peden EK. Complex left profunda femoris vein to renal vein bypass for the management of progressive chronic iliofemoral occlusion. Ann Vasc Surg 2013; 27(1): 112 e5-8.
