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Chronic Obstruction of the Inferior Vena Cava

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Current Management of Venous Diseases

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Abstract

 Although chronic occlusion of the vena cava is a relatively rare clinical entity, symptoms can be significant and debilitating in certain patients. The minority of cases arise secondary to congenital defects of the central veins, but much more frequently it is associated with malignancy and a systemic hypercoagulable state, or from instrumentation such as insertion of inferior vena cava filters. The degree of symptoms is the primary driver for intervention; this is usually reserved for patients with CEAP classifications C3 – C6. The current treatment paradigm emphasizes an endovascular-first approach, with open bypass still representing a good option for select patients. Provided the lesion can be crossed, good long-term outcomes can be achieved with balloon venoplasty, with or without stenting. Thrombosis due to IVC filters can also be crossed, and the filter crushed and displaced with a Palmaz stent to create a flow channel. Following intervention, the majority of patients should be maintained on systemic anticoagulation, with compression therapy and local wound care as needed.

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Authors and Affiliations

  1. Department of Vascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA

    Jordan R. Stern MD & Andrew J. Meltzer MD, FACS

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  1. Jordan R. Stern MD
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  2. Andrew J. Meltzer MD, FACS
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Correspondence to Andrew J. Meltzer MD, FACS .

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Editors and Affiliations

  1. Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Cassius Iyad Ochoa Chaar

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Stern, J.R., Meltzer, A.J. (2018). Chronic Obstruction of the Inferior Vena Cava. In: Chaar, C. (eds) Current Management of Venous Diseases . Springer, Cham. https://doi.org/10.1007/978-3-319-65226-9_40

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  • DOI: https://doi.org/10.1007/978-3-319-65226-9_40

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