Ilio-Caval Outflow Obstruction

Prepared by William Marston, MD

Corresponding chapter in Handbook of Venous Disorders: Chapters 44, 45 and 46

• Neglén P, Hollis KC, Olivier J, Raju S. Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg 2007;46: 979-90.

PMID: 17980284

Comment: The extensive experience of Drs. Neglen and Raju in the treatment of venous outflow intervention is summarized in this manuscript. Over 980 cases were followed for a mean of 22 months with assessment of outflow patency as well as quality of life scores in
this comprehensive analysis.

• Labropoulos N, Borge M, Pierce K, Pappas PJ. Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg 2007;46:101-7.

PMID: 17540535

Comment: Diagnostic criteria for clinically significant venous ouflow stenosis remain controversial. Some authors including Neglen and Raju recommend intravascular ultrasound as the most sensitive and specific modality. This manuscript provides a description of criteria using non-invasive ultrasound that may be used as an initial screen for the detection of central venous stenosis.

• Delis KT, Bjarnason H, Wenneberg PW, Rooke TW, Gloviczki P. Successful iliac vein and inferior vena cava stenting ameliorates venous claudication and improves venous outflow, calf muscle pump function and clinical status in post-thrombotic syndrome. Ann Surg 2007;245:130-9.

PMID: 17197976

Comment: Detailed evaluation of the hemodynamic and symptomatic improvement resulting from iliac and/or IVC stenting
in patients with advanced venous disease. Successful recanalization of the venous outflow tract results in significant improvement in calf muscle pump function.

• Neglén P, Tackett P, Raju S. Venous stenting across the inguinal ligament. J Vasc Surg 2008;48:1255-61.

PMID: 18771877

Comment: A key determinant of outcome after ilio-cavalvenous stenting relates to the adequacy of inflow into the iliac through the common femoral vein. This manuscript discusses a large series of patients in whom stenting was required below the inguinal ligament to achieve adequate inflow. Technical issues and outcomes are discussed in detail.

• Jost CJ, Gloviczki P, Cherry KJ, McKusick MA, Harmsen WA, Jenkins GD, Bower TC. Surgical reconstruction of iliofemoral veins and the inferior vena cava for nonmalignant occlusive disease. J Vasc Surg 2001;33:320-8.

PMID: 11174784

Comment: Surgical options for reconstruction of the venous outflow tract are discussed along with outcome information for autogenous and prosthetic options.