ILIOCAVAL COMPLICATIONS OF RETROPERITONEAL FIBROSIS

BACKGROUND: Retroperitoneal fibrosis can compress ureters, nerves, and blood vessels in the abdomen. However, clinically significant large-v ein obstruction secondary to this process is rare. METHODS: Three hund red forty patients with retroperitoneal fibrosis were treated at our i nstitution between 1976 and 1993. The clinical data from seven of thes e patients, who were treated for iliocaval complications of retroperit oneal fibrosis, were reviewed. RESULTS: Six patients had signs and sym ptoms of chronic obstruction, and one patient presented with acute ili ocaval thrombosis and underwent attempt at venous thrombectomy in the referring hospital. All patients exhibited extremity edema and three h ad venous claudication. Iliocaval occlusion was confirmed in all patie nts by venography, computed tomography, or magnetic resonance imaging. The obstructive process involved the iliocaval tree (four patients), the inferior vena cava alone (two patients), and the iliac vein alone (one patient). Five patients were managed conservatively with leg elev ation, compression stockings, and anticoagulation. Two patients receiv ed prednisone. One patient underwent and iliocaval bypass from the ext ernal iliac vein to the juxtarenal cava using a ringed polytetrafluoro ethylene graft with a femoral arteriovenous fistula. A second patient with an isolated left common iliac vein obstruction underwent a left-t o-right femorofemoral saphenous vein bypass. Four patients treated con servatively continued to have extremity edema. The two patients manage d surgically remain asymptomatic from venous insufficiency, with paten t grafts at 25 and 12 months after surgery, respectively. CONCLUSION: Iliocaval obstruction is an unusual complication of retroperitoneal fi brosis. Although most cases can be managed conservatively, reconstruct ion is an option for patients who have failed medical treatment and ar e symptomatic secondary to chronic venous obstruction. Lifelong antico agulation should be considered for all patients with progressive ilioc aval obstruction secondary to retroperitoneal fibrosis.