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has been observed and a few cases of retroperitoneal hematoma requiring blood
transfusions have been described (14,48). The utilization of ultrasound guided cannulation
and closure of the cannulation site with collagen plugs have largely abolished these
problems. The mortality has been nil.
Studies of venous stenting in peer review publications often have similar short
comings as reports for open surgery. Most studies are case reports and few are sizable, the
follow-up is short-term and patency not reported in cumulative fashion, stented sites in the
upper and lower extremities are mixed, and the majority of the reports series have not
differentiated between etiologies or in management of acute and chronic conditions. In a
group of patients, Nazarian et al. reported a one-year primary assisted patency rate of 66% of
29 iliac obstructions of mixed etiologies (49). The lower patency rate may be explained by
the selection of patients (13/29 had complete occlusion and 16/19 were caused by
malignancy). Interestingly, few occlusions occurred after six months, and the patency rate
remained the same at one- and four-year follow-up. The same group has also reported an
overall primary and secondary one-year primary and secondary patency rate of 50% and
81%, respectively, ina mixed population including 56 patients withiliac obstruction caused
by malignancy, trauma, pregnancy, and postoperative stenosis (50).
Binkert et al. reported a 100% patency at an average follow-up time of three years in
eight patients with chronic and acute pelvic vein obstruction (in four limbs following
surgical thrombectomy) with resolution or substantial improvement of symptoms in most
patients (51). Similarly, O’Sullivan et al. have reported a one-year patency of 79% in a
retrospective analysis of 39 patients (52). Only half of the patients was stented for chronic
symptoms (12/20 had adjuvant lysis); the remaining half presented with acute deep vein
thrombosis and was treated after successful thrombolysis. Excluding initial technical
failures, the stented patients had a one-year patency of 94% and 92% in respective group.
The clinical results were excellent in the stented limbs.
Figure 5 Patient with recurrent ovarial carcinoma resulting in external iliac vein obstruction. The
patency of the stent is mostly related to the behavior of the malignancy.
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Juhan et al. stented 15 limbs (six following open thrombectomy) and showed a
venographic primary and secondary venographic patency of 87% and 93%, respectively,
at mean follow-up of 24 mo (range 5–52). More than 80% of patients had satisfactory
result and mean clinical and severity score decrease substantially to less than one (53).
Lamont et al. inserted 15 flexible stents in 15 limbs (9 following acute DVT removal) and
achieved cumulative secondary patency rate of 87% at 41 mo as measured by Duplex
ultrasound (54). Similarly to Juhan et al. 80% (12/15) were asymptomatic. Symptoms
were only mild in the three symptomatic limbs (Fig. 4).
ILIOCAVAL STENTING FOLLOWING THROMBOLYSIS/
THROMBECTOMY FOR ACUTE DVT
An unveiled proximal chronic obstruction of the iliac vein following thrombectomy or
lysis is known to decrease future patency if not treated. Juhan et al. reported in patients
undergoing surgical thrombectomy a low rethrombosis rate of 7% in limbs without
stenosis versus 56% in limbs with severe stenosis (55). Mickley et al. found a rethrombosis
rate of 13% if the underlying stenosis was stented as compared to 73% when not
treated (56). In a retrospective study of thrombectomized limbs (1985–1995) Wohlgemuth
et al. showed that there was no difference in patency rate between venous balloon
angioplasty alone and stenting (approximately 66%) in 34 limbs (57). The evaluation was
not prospective and only 7/34 limbs had stenting. However, the rethrombosis rate
increased form 14% to 57% when remaining thrombosis or lesions were found on
angioscopy post-thrombectomy. None of these papers relate the clinical result to any
remaining partial obstruction.
In the report introducing thrombolysis as a valuable treatment option for acute
iliofemoral venous thrombosis, Semba et al. performed balloon angioplasty and stent
placement in more than 50% of limbs with an early patency rate of 85% (58). A gigantic
multi-center registry collected data on 473 limbs with iliofemoral thrombosis treated by a
wide variety of endovascular techniques (59). Limbs with ilio-caval stent placement had a
greater one-year patency as compared to limbs undergoing only balloon angioplasty (74%
and 53%, respectively).
It appears that the patency rates after stent placement following immediate removal
of acute thrombosis and in treatment of chronic postthrombotic disease are similar.
Presently, the general consensus is to treat any underlying remaining stenosis after clot
removal (thrombolysis, mechanical clot removal or open thrombectomy) by percutaneous
stenting. Balloon angioplasty alone appears to be insufficient.
STENTING OF CHRONIC NONMALIGNANT OBSTRUCTION
Bla
¨
ttler and Bla
¨
ttler reported in 1999 treatment of chronic venous and neurogenic
claudication due to pelvic venous blockage and achieved 100% patency in 11
successfully stented limbs with a mean follow-up of 15 months (range 1–43 months).
The clinical success rate was 81% (9/11) (60). A group of 18 patients were reported
by Hurst et al. (14). Twelve limbs were treated for chronic obstruction. The primary
patency rates at 12 and 18 months were 79% and 79%, respectively. Most patients
(72%) had resolution or substantial improvement of leg swelling and pain. However,
five remaining patients continued to have pain despite resolved swelling and widely
patent stents on venogram.
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Several reports have been published by our group describing results after stenting of
pelvic and caval veins in patients with chronic non malignant occlusions without any pre-
treatment of acute deep vein thrombosis (48,61–64). Cumulative patency rates based on
venographic findings as defined by reporting standards of SVS/ISCVS (65), frequency of
in-stent recurrent stenosis, clinical results assessing pain, swelling and ulcer healing, and
limited quality-of-life data are available. The obstructive lesion in these reports was
considered postthrombotic when the patient had a known history of DVT or when
postthrombotic changes was found on venography or ultrasound at any level of the lower
extremity. The remaining limbs were considered non-thrombotic (“primary”). No
obstructions due to malignancy were included.
Transfemoral venogram was performed after treatment in 324/455 limbs which
underwent iliac vein stenting between 1997 and 2001 (61,62,66). Cumulative primary,
assisted-primary and secondary patency rates at four years were 72%, 92% and 93%,
respectively. The stented limbs with non-thrombotic disease appeared to fare significantly
better than did those with thrombotic disease (primary, assisted-primary and secondary
cumulative patency rates of 89%, 100% and 100%, and 65%, 85% and 88% at 36 months,
respectively) (Table 4).
Although some degreeof in-stent recurrent stenosis (ISR) iscommon (only 23% were
completely freeof any stenosis at 42 months), severe in-stent recurrentstenosis, i.e., O50%
diameter decrease on single plane anterior-posterior venogram, is infrequent (only 15%
present in 42 months) (66). Several factors, which may potentially influence the
development of ISR, were analyzed. Gender and sidedness of limb involvement did not
affect outcome. Cumulative higher rates of severe IRS occurred with treatment of
thrombotic than in nonthrombotic limbs (23% and 4%, respectively) at 36 months, and in
the presence of thrombophilia (18% and 12%,respectively). The data concerning the length
of stented area and extension of stent system to below the inguinal ligament appears
intimately connected. Length of stented area 13–35 cm and extension of stent to below the
inguinal ligament had a cumulative rate of severe ISR of 25% at 36 months and 40% at
24 months, respectively.
The strong impact of the thrombotic disease on development of in-stent restenosis
appears to be reflected in the analysis of other potential contributing factors. There was an
overrepresentation of limbs with thrombotic disease in patients with thrombophilia, long
Table 4 Cumulative Patency Rates and Frequency of In-Stent Restenosis After Iliofemoral
Venous Stenting
Cumulative patency rate (%)
Follow-up
time (months) Primary Primary-assisted Secondary
All limbs (nZ324) 36 75 92 93
Thrombotic limbs (nZ175) 36 65 85 88
Nonthrombotic limbs (nZ147) 36 89 100 100
Cumulative in-stent restenosis rate (%)
0 O20 O50
All limbs (nZ316) 42 23 61 15
Thrombotic limbs (nZ156) 36 – 63 23
Nonthrombotic limbs (nZ145) 36 – 41 4
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stents, and stents terminating below the inguinal ligament, which all had higher rates of in-
stent restenosis. The result may reflect treatment of a more severe and extensive disease
seen in limbs with thrombotic disease.
Although groups of limbs with multiple follow-up venograms do not unequivocally
show an increase of stenosis over time, there is no doubt that there may be significant
progress in individual cases. Whether the late occlusions occur due to acute recurrent
thrombosis or due to gradual development of true intimal hyperplasia requires further
study. The three major risk factors for development of ISR and late occlusion appear
similar. At 24 months post-stenting, limbs with the three risk factors outlined above
showed a 61% rate of severe in-stent restenosis, while none developed in their absence. No
conclusion regarding a cause–effect relationship can be drawn from this paper.
As alluded to above, the reports describing patency rates indicate clinical improvement
in most patients(O80%) (51,52). Hurst et al. showedresolutionor substantial improvementin
72% of limbs (14). In addition toassessmentof ulcer healing, Rajuand Negle
´
n have evaluated
pain, swelling and quality-of-life. The degree of swelling was assessed by physical
examination (Grade 0: none, Grade 1: pitting, not obvious, Grade 2: ankle edema Grade 3:
obvious swelling involving the limb), the level of pain was measured by the visual analogue
scale method (67), and quality-of-life by a questionnaire, validated for assessment of chronic
venous insufficiency (68). The incidence of ulcer healing after iliac vein balloon dilation and
stent placement in 41 limbs with active ulcer was 68% and the cumulative ulcer recurrence-
free rate at two years was 62% (61). During the observation period no additional surgery was
performed to treat reflux. Median swelling and pain severity scores decreased significantly
(grade 2 to 1 and 4 to 0, respectively). The frequency of limbs with any swelling decreased
significantly from 88% to 53% and limbs with any pain fell from 93% to 29%. The
improvement of pain and swelling was significant in both ulcerated and non-ulcerated limbs,
indicating that the ulcer was not the only cause of pain and swelling. Using a quality-of-life
questionnaire assessing subjective pain, sleep disturbance, morale and social activities,
routine and strenuous physical activities, the patients indicated significant improvement in all
major categories after venous stenting. The clinical outcome is favorable in the intermediate
term. The results clearly indicate a significant symptom relief after balloon angioplasty and
stent placement to treat iliac venous outflow obstruction.
ENDOVASCULAR TECHNIQUE
Balloon angioplasty with stenting of the venous system is minimally invasive and
straightforward to perform, but attention to details is important to achieve satisfactory
results. The detailed technique is described elsewhere (48,52,63,64). Venous stenting is
fundamentally a different procedure from stenting in the arterial system, e.g., the “kissing”
balloon technique and the confluence of the common iliac veins or insertion of bilateral
stents is not necessary. The cannulation of the femoral vein under ultrasound guidance has
largely eliminated access complications. There is no problem of hemostasis, even in the
middle of the thigh, as would be encountered after arterial puncture.
It has previously been shown that simple balloon dilation leads to early restenosis
and an immediate recoil of the iliac vein has been observed intraoperatively in the majority
of limbs (69–71). Therefore, stenting is advised of most dilated obstructions, especially
when immediate significant recoil occur or the external compression is excessive. The
intravascular ultrasound (IVUS) is invaluable, both as a diagnostic tool and as an intra-
operative aid to direct placement of the stent.
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If a braided stent, e.g., Wallstent
w
, is used, it should be placed well into the IVC in
stenosis closed to the confluence of the common iliac veins. Owing to its inherent
properties it is otherwise frequently displaced (“squeezed”) distally and a proximal
restenosis may develop (48). This IVC placement raises concern for risk of occlusion of
the contralateral limb. The stent does, however, not appear to significantly impair the flow
from the contralateral limb resulting in thrombosis. Only a few cases of contralateral limb
DVT has been observed and appear to be caused by recurrent attacks of thrombosis.
Insertion of a self expanding flexible large stent (14–16 mm diameter) is
recommended. The vein seems to accept extensive dilation without clinical rupture
contrary to the artery. No clinical rupture of the vein has so far been reported, even
when a total occlusion is recanalized and dilated up to 16 mm width. Re-dilatation after
stent insertion is mandatory to achieve a good wall apposition as evaluated by IVUS.
The inflow and outflow of the stent can not be impeded to ensure long-term
patency. Therefore, it is vital to cover the entire obstruction as outlined by the IVUS.
Short skip areas in between two stents should be avoided. There should be no hesitation
to extend the stent below the inguinal ligament if the lesion reaches the common
femoral vein. The occlusion rate does not appear to be related to the length of stent or
metal load per se, but to incomplete treatment or other factors (Table 5).
The perioperative thrombosis prophylaxis is fairly standardized in all patients. The
patient received 2500 units subcutaneously of dalteparin preoperatively. During the
procedure, 5.000 units of unfractionated heparin and 30 mg ketorolac were administered
intravenously. All patients were admitted for less than 23 hours. Postoperatively, a foot
compression device was applied, dalteparin 2500 units administered subcutaneously in
the recovery room; and a ketorolac injection and dalteparin 5000 units repeated in the
morning before discharge. Low dose aspirin (81 mg p.o.) daily was started immediately
postoperatively and continued. Most patients did not have additional anticoagulation.
Only patients already on warfarin preoperatively owing to prior recurrent deep vein
thrombosis and/or thrombophilia or those with significant thrombophilia discovered
preoperatively were anticoagulated postoperatively. These were a minority, often on
Table 5 Technical Recommendations
1. Venous balloon angioplasty and stenting is conceptually different from that employed in the
arterial system.
2. The “kissing” balloon technique and insertion of bilateral stents necessary at the aortic
bifurcation is superfluous at the confluence of the common iliac veins.
3. Balloon angioplasty is most often insufficient in the venous system and stenting routine.
4. Ultrasound to guide cannulation of the femoral vein prevents complications.
5. IVUS is invaluable, both as a diagnostic tool and as an intra-operative aid, to direct stent
placement.
6. Braided stents adjacent to the confluence of the common iliac veins must be placed well into the
IVC to avoid early restenosis (retrograde migration).
7. Insertion of a large diameter stent (14–16 mm wide) is recommended. Unlike the artery, the vein
accepts extensive dilation without clinical rupture.
8. Post insertion stent dilation is vital to prevent migration.
9. The most common cause of early restenosis is inadequate stenting of the lesion. The obstructive
vein segment is usually more extensive than shown on venography. Cover the entire diseased
venous segment as outlined by IVUS.
10. Avoid short skip areas (!5 cm) between two stents since these are prone to develop secondary
stenosis.
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life-long anticoagulation. Warfarin was routinely discontinued prior to surgery, and
5000 units of dalteparin were injected during the days warfarin had been discontinued.
SUMMARY
Interest in venous outflow obstruction is increasing with the emergence of practical
treatment alternatives. The lack of accurate objective non-invasive or invasive test for
evaluation of hemodynamically significant obstruction makes the selection of patients
difficult. Presently patients have to be selected on clinical signs and symptoms with a high
index of suspicion, and final diagnosis and treatment has to be based on morphological
investigations. Transfemoral venography (multi-plane if possible), or preferably IVUS,
should probably be utilized more generously in the work-up of patients with significant
signs and symptoms of chronic venous disorder, especially in patients with leg ulcer or
previous thrombosis.
Venous balloon angioplasty and stenting appears to be a safe, relatively simple,
and efficient method to treat ilio-caval vein obstruction, at least in the mid-term. An
immediate or late failure of the procedure does not preclude later open surgery to
correct the obstruction. Associated reflux may be controlled subsequently when
necessary. Open bypass surgery will probably be reserved for those patients in whom
stenting initially could not be performed for technical reasons, late failures which can
not be adequately disobliterated, and long total occlusions, which appear to have a
poorer result.
Although venous stenting appears to be a promising treatment some caveats are
necessary. The technology is relatively recent; thus, the follow-up period is limited. The
long-term effects of stents in the venous system are not fully known. Several more years of
monitoring is required to assess the efficacy and safety of this therapeutic modality in
venous disease. In addition, further research on understanding the nature of venous
obstruction and development of reliable methods to test hemodynamic consequences are
needed.
KEY POINTS
† The lack of accurate objective non-invasive or invasive test for evaluation of
hemodynamically significant obstruction makes the selection of patients
difficult.
† Transfemoral multi-plane venography or, preferably, intravascular ultrasound
should be utilized more generously in the work-up of patients with significant
signs and symptoms of chronic venous disorder.
† Venous balloon angioplasty and stenting appears to be a safe, relatively simple,
and efficient method to treat iliocaval vein obstruction.
† An immediate or late failure of the endovenous procedure does not preclude later
open surgery to correct the obstruction.
† Open bypass surgery is mostly reserved for patients in whom stenting initially
could not be performed for technical reasons, late failures which can not be
adequately disobliterated, and long total occlusions, which appear to have a
poorer result.
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REFERENCES
1. Johnson BF, Manzo RA, Bergelin RO, Strandness DE, Jr. The site of residual abnormalities in
the leg veins in long-term follow-up after deep vein thrombosis and their relationship to the
development of the post-thrombotic syndrome. Int Angiol 1996; 15:14–19.
2. Johnson BF, Manzo RA, Bergelin RO, Strandness DE, Jr. Relationship between changes in the
deep venous system and the development of the postthrombotic syndrome after an acute
episode of lower limb deep vein thrombosis: a one- to six-year follow-up. J Vasc Surg 1995;
21:307–312; discussion 313.
3. Nicolaides AN, Hussein MK, Szendro G, Christopoulos D, Vasdekis S, Clarke H. The relation of
venousulcerationwithambulatoryvenouspressure measurements. JVasc Surg1993;17:414–419.
4. Nicolaides AN, Sumner DS. Investigations of patients with deep vein thrombosis and chronic
venous insufficiency. Los Angeles, CA: Med-Orion Publishing Co, 1991.
5. May R. Anatomy. Surgery of the veins of the leg and pelvis. Stuttgart, Germany: Georg Thieme
Verlag, 1979:1–36.
6. Mavor GE, Galloway JM. Collaterals of the deep venous circulation of the lower limb. Surg
Gynecol Obstet 1967; 125:561–571.
7. Plate G, Akesson H, Einarsson E, Ohlin P, Eklof B. Long-term results of venous thrombectomy
combined with a temporary arteriovenous fistula. Eur J Vasc Surg 1990; 4:483–489.
8. Mavor GE, Galloway JM. Iliofemoral venous thrombosis. Pathological considerations and
surgical management. Br J Surg 1969; 56:45–59.
9. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the
pelvic veins. Angiology 1957; 8:419–427.
10. Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg 1965; 52:816–821.
11. Raju S, Neglen P. Laser, “Closure,” stents and other new technology in the treatment of venous
disease. J Miss State Med Assoc 2004; 45:290–297.
12. Cockett FB, Thomas ML, Negus D. Iliac vein compression—Its relation to iliofemoral
thrombosis and the post-thrombotic syndrome. Br Med J 1967; 2:14–19.
13. Neglen P, Thrasher TL, Raju S. Venous outflow obstruction: An underestimated contributor to
chronic venous disease. J Vasc Surg 2003; 38:879–885.
14. Hurst DR, Forauer AR, Bloom JR, Greenfield LJ, Wakefield TW, Williams DM. Diagnosis and
endovascular treatment of iliocaval compression syndrome. J Vasc Surg 2001; 34:106–113.
15. Labropoulos N, Volteas N, Leon M, et al. The role of venous outflow obstruction in patients
with chronic venous dysfunction. Arch Surg 1997; 132:46–51.
16. Neglen P, Raju S. Detection of outflow obstruction in chronic venous insufficiency. J Vasc Surg
1993; 17:583–589.
17. Raju S. A pressure-based technique for the detection of acute and chronic venous obstruction.
Phlebology 1988; 3:207–216.
18. Raju S, Fredericks R. Venous obstruction: an analysis of one hundred thirty-seven cases with
hemodynamic, venographic, and clinical correlations. J Vasc Surg 1991; 14:305–313.
19. Nicolaides AN. In: Outflow obstruction. Los Angeles, CA: Med-Orion Publishing Co, 1991:56–62.
20. Neglen P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg
2002; 35:694–700.
21. Forauer AR, Gemmete JJ, Dasika NL, Cho KJ, Williams DM. Intravascular ultrasound in the
diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv
Radiol 2002; 13:523–527.
22. Satokawa H, Hoshino S, Iwaya F, Igari T, Midorikawa H, Ogawa T. Intravascular Imaging
Methods for Venous Disorders. Int J Angiol 2000; 9:117–121.
23. Taheri SA, Williams J, Powell S, et al. Iliocaval compression syndrome. Am J Surg 1987;
154:169–172.
24. Lalka SG, Lash JM, Unthank JL, et al. Inadequacy of saphenous vein grafts for cross-femoral
venous bypass. J Vasc Surg 1991; 13:622–630.
25. Eklof B, Albrechtson U, Einarsson E, Plate G. The temporary arteriovenous fistula in venous
reconstructive surgery. Int Angiol 1985; 4:455–462.
Negle
´
n and Raju424
https://t.me/med1917
26. Palma EC, Esperon R. Vein transplants and grafts in the surgical treatment of the postphlebitic
syndrome. J Cardiovasc Surg (Torino) 1960; 1:94–107.
27. Danza R, Navarro T, Baldizan J. Reconstructive surgery in chronic venous obstruction of the
lower limbs. J Cardiovasc Surg (Torino) 1991; 32:98–103.
28. 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; 33:320–327
discussion 327–8.
29. AbuRahma AF, Robinson PA, Boland JP. Clinical, hemodynamic, and anatomic predictors of
long-term outcome of lower extremity venovenous bypasses. J Vasc Surg 1991; 14:635–644.
30. Halliday P, Harris J, May J. Femoro-femoral crossover grafts (Palma operation): A long-term
follow-up study. Surgery of the veins. Orlando, FL: Grune & Stratton 1985:241–254.
31. O’Donnell TF, Jr., Mackey WC, Shepard AD, Callow AD. Clinical, hemodynamic, and
anatomic follow-up of direct venous reconstruction. Arch Surg 1987; 122:474–482.
32. Husni EA. In: Clinical experience with femoropopliteal venpus reconstruction. Chicago, IL:
Yearbook Medical Publishers, 1978:485–491.
33. Gruss JD. In: Venous bypass for chronic venous insufficiency. Philadelphia, PA: WB Saunders,
1991:316–330.
34. Hutschenreiter S, Vollmar J, Loeprecht H, Abendschein A, Rodl W. Rekonstruktive Eingriffe
am Venensystem: Spatergebnisse unter Kritischer Bewertung funktioneller und gefassmor-
phologischer Kriterien. Chirurg 1979; 50:555–563.
35. Yamamoto N. Reconstruction with insertion of expanded polytetrafluoroethylene (PTFE) graft
for iliac venous obstruction. J Cardiovasc Surg 1986; 27:697–702.
36. Comerota AJ, Aldridge SC, Cohen G, Ball DS, Pliskin M, White JV. A strategy of aggressive
regional therapy for acute iliofemoral venous thrombosis with contemporary venous
thrombectomy or catheter-directed thrombolysis. J Vasc Surg 1994; 20:244–254.
37. Gruss JD, Hiemer W. Bypass procedures for venous obstruction: Palma and May-Husni
bypasses, Raju perforator bypass, prosthetic bypasses, and primary and adjunctive
arteriovenous fistulae. In: Surgical management of venous disease. Baltimore, MD:
Williams & Wilkins, 1997:289–305.
38. Plate G, Einarsson E, Eklof B, Jensen R, Ohlin P. Iliac vein obstruction associated with acute
iliofemoral venous thrombosis. Results of early reconstruction using polytetrafluoroethylene
grafts. Acta Chir Scand 1985; 151:607–611.
39. Gloviczki P, Pairolero PC, Toomey BJ, et al. Reconstruction of large veins for nonmalignant
venous occlusive disease. J Vasc Surg 1992; 16:750–761.
40. Ijima H, Kodama M, Hori M. Temporary arteriovenous fistula for venous reconstruction using
synthetic graft: a clinical and experimental investigation. J Cardiovasc Surg (Torino) 1985;
26:131–136.
41. Okadome K, Muto Y, Eguchi H, Kusaba A, Sugimachi K. Venous reconstruction for
iliofemoral venous occlusion facilitated by temporary arteriovenous shunt. Long-term results
in nine patients. Arch Surg 1989; 124:957–960.
42. Alimi YS, DiMauro P, Fabre D, Juhan C. Iliac vein reconstructions to treat acute and chronic
venous occlusive disease. J Vasc Surg 1997; 25:673–681.
43. Dale WA, Harris J, Terry RB. Polytetrafluoroethylene reconstruction of the inferior vena cava.
Surgery 1984; 95:625–630.
44. Husfeldt KJ. Venous replacement with Gore-tex prosthesis: experimental and first clinical
results. In: Pelvic and abdominal veins: Progress in diagnostics and therapy. Amsterdam:
Excerpta Medica, 1981:249–258.
45. Bower TC, Nagorney DM, Cherry KJ, Jr., et al. Replacement of the inferior vena cava for
malignancy: an update. J Vasc Surg 2000; 31:270–281.
46. Husni EA. In situ saphenopopliteal bypass graft for incompetence of the femoral and popliteal
veins. Surg Gynecol Obstet 1970; 130:279–284.
47. Frileux C, Pillot-Bienayme P, Gillot C. Bypass of segmental obliterations of ilio-femoral
venous axis by transposition of saphenous vein. J Cardiovasc Surg (Torino) 1972; 13:409–414.
Management of Deep Venous Obstruction 425
https://t.me/med1917
48. Neglen P, Raju S. Balloon dilation and stenting of chronic iliac vein obstruction: technical
aspects and early clinical outcome. J Endovasc Ther 2000; 7:79–91.
49. Nazarian GK, Austin WR, Wegryn SA, et al. Venous recanalization by metallic stents after
failure of balloon angioplasty or surgery: four-year experience. Cardiovasc Intervent Radiol
1996; 19:227–233.
50. Nazarian GK, Bjarnason H, Dietz CA, Jr., BernadasCA, HunterDW. Iliofemoral venous stenoses:
effectiveness of treatment with metallic endovascular stents. Radiology 1996; 200:193–199.
51. Binkert CA, Schoch E, Stuckmann G, et al. Treatment of pelvic venous spur (May-Thurner
syndrome) with self-expanding metallic endoprostheses. Cardiovasc Intervent Radiol 1998;
21:22–26.
52. O’Sullivan GJ, Semba CP, Bittner CA, et al. Endovascular management of iliac vein
compression (May-Thurner) syndrome. J Vasc Interv Radiol 2000; 11:823–836.
53. Juhan C, Hartung O, Alimi Y, Barthelemy P, Valerio N, Portier F. Treatment of nonmalignant
obstructive iliocaval lesions by stent placement: mid-term results. Ann Vasc Surg 2001;
15:227–232.
54. Lamont JP, Pearl GJ, Patetsios P, et al. Prospective evaluation of endoluminal venous stents in
the treatment of the May-Thurner syndrome. Ann Vasc Surg 2002; 16:61–64.
55. Juhan CM, Alimi YS, Barthelemy PJ, Fabre DF, Riviere CS. Late results of iliofemoral venous
thrombectomy. J Vasc Surg 1997; 25:417–422.
56. Mickley V, Schwagierek R, Rilinger N, Gorich J, Sunder-Plassmann L. Left iliac venous
thrombosis caused by venous spur: treatment with thrombectomy and stent implantation.
J Vasc Surg 1998; 28:492–497.
57. Wohlgemuth WA, Weber H, Loeprecht H, Tietze W, Bohndorf K. PTA and stenting of benign
venous stenoses in the pelvis: long-term results. Cardiovasc Intervent Radiol 2000; 23:9–16.
58. Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-
directed thrombolysis. Radiology 1994; 191:487–494.
59. Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH.
Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a
national multicenter registry. Radiology 1999; 211:39–49.
60. Blattler W, Blattler IK. Relief of obstructive pelvic venous symptoms with endoluminal
stenting. J Vasc Surg 1999; 29:484–488.
61. Raju S, Owen S, Jr., Neglen P. The clinical impact of iliac venous stents in the management of
chronic venous insufficiency. J Vasc Surg 2002; 35:8–15.
62. Neglen P. Endovascular treatment of chronic iliofermoral venous obstruction - A review.
Phlebolymphology 2003; 43:204–211.
63. Neglen P, Berry MA, Raju S. Endovascular surgery in the treatment of chronic primary and
post-thrombotic iliac vein obstruction. Eur J Vasc Endovasc Surg 2000; 20:560–571.
64. Raju S, McAllister S, Neglen P. Recanalization of totally occluded iliac and adjacent venous
segments. J Vasc Surg 2002; 36:903–911.
65. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International
Consensus Committee on Chronic Venous Disease. J Vasc Surg 1995; 21:635–645.
66. Neglen P, Raju S. In-stent recurrent stenosis in stents placed in the lower extremity venous
outflow tract. J Vasc Surg 2004; 39:181–187.
67. Scott J, Huskisson EC. Graphic representation of pain. Pain 1976; 2:175–184.
68. Launois R, Reboul-Marty J, Henry B. Construction and validationof aquality of life questionnaire
in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res 1996; 5:539–554.
69. Marzo KP, Schwartz R, Glanz S. Early restenosis following percutaneous transluminal balloon
angioplasty for the treatment of the superior vena caval syndrome due to pacemaker-induced
stenosis. Cathet Cardiovasc Diagn 1995; 36:128–131.
70. Neglen P, al-Hassan HK, Endrys J, Nazzal MM, Christenson JT, Eklof B. Iliofemoral venous
thrombectomy followed by percutaneous closure of the temporary arteriovenous fistula.
Surgery 1991; 110:493–499.
71. Wisselink W, Money SR, Becker MO. Comparison of operative reconstruction and percutaneous
balloondilatation for centralvenous obstruction.Am J Surg1993;166:200–204;discussion 204–5.
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SECTION F: OTHER VENOUS CONDITIONS
32
Upper-Extremity Venous Thrombosis
Klaus Overbeck and Shankat N. Khan
Northern Vascular Centre, Freeman Hospital, Newcastle
upon Tyne, U.K.
Gerard Stansby
University of Newcastle upon Tyne, Newcastle upon Tyne, U.K.
Nicos Labropoulos
Vascular Laboratory, Division of Vascular Surgery, New Jersey Medical School,
Newark, New Jersey, U.S.A.
INTRODUCTION
Of all cases of deep venous thrombosis (DVT), the veins of the upper limb are involved in
1–4% (1–6) with “Primary thrombosis” or Paget-Schroetter Syndrome (PSS), accounting
for approximately 20% of these in recent series. When Paget and Schroetter independently
described their syndrome the underlying causes were mostly obscure but by now an
underlying pathology can often be found. These include an association with inherited or
acquired disorders of coagulation and abnormality or variations in the anatomy of the
thoracic outlet (7). Approximately 40% of upper limb DVT is secondary to indwelling
catheters. This form of thrombosis is referred to as secondary thrombosis.
ETIOLOGY
Primary Upper-Extremity Venous Thrombosis
The anatomical arrangement of the thoracic outlet is complex. Three main spaces have
been described (8).
† The prescalene space (clavicle anteriorly and the anterior scalene muscle
posteriorly)
† The costoclavicular space (the triangular space bounded anteriorly by the inner
half of the clavicle and subclavius muscle and posteromedially by the first rib)
† The retropectoralis minor space (defined anteriorly by the posterior border of the
pectoralis minor and posteriorly by the subscapularis muscle)
All of these are narrowed during elevation and hyperabduction of the arm resulting
in compression of the axillary/subclavian vein (8,9). It has been postulated that such
movement can cause repeated mechanical injury to the vein, augmented by adjoining
bone, ligament and muscle structures (10–12).
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