Abstract
Purpose of Review
Reconstruction of the iliocaval system is primarily performed in symptomatic patients with obstructive chronic venous disease (CVD). Such pathology can be primary/nonthrombotic or secondary/postthrombotic. The former encompasses pathology including May–Thurner syndrome, the most common etiology of primary CVD responsible for up to a third of the disease burden. Secondary CVD is usually due to postthrombotic syndrome. Other indications for iliocaval reconstructions include malignancy involving the iliocaval territory, trauma, or radiation injury. In this review, we evaluate complex iliocaval venous reconstructions vis-a-vis indications, approaches, outcomes, and complications.
Recent Findings
Treatment of CVD is initially conservative with the use of compression stockings. A surgical route is chosen when the former fails or cannot be applied. Both open and endovascular surgical approaches exist with the latter having supplanted open approaches as the choice of intervention except in cases where an endovascular approach cannot be pursued, has failed, or in patients with malignancy where tumor removal is required. Hybrid procedures are performed occasionally when femoral vein exposure and endophlebectomy or creation of an arteriovenous fistula is required to improve inflow following surgical intervention.
Summary
Endovascular reconstruction of the iliocaval system can be done with minimal morbidity and mortality with excellent long-term results. Open iliocaval revascularization has a limited role in candidates with acceptable risk and is associated with good outcomes in such patients.
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Dr. Jayaraj declares no conflicts of interest relevant to this manuscript. Dr. Raju declares a patent for a venous stent, a patent for IVUS pending, and stock in Veniti, Inc.
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Jayaraj, A., Raju, S. Review of Complex Iliocaval Reconstructions. Curr Surg Rep 4, 34 (2016). https://doi.org/10.1007/s40137-016-0154-1
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DOI: https://doi.org/10.1007/s40137-016-0154-1