ILIAC VEIN RECONSTRUCTIONS TO TREAT ACUTE AND CHRONIC VENOUS OCCLUSIVE DISEASE

Purpose: The treatment of permanent and benign iliac vein occlusion re sponsible for acute vein thrombosis or chronic symptoms remains contro versial. Different methods of reconstruction using a reinforced expand ed polytetrafluoroethylene bypass graft associated with an arterioveno us fistula and their intermediate-term results are analyzed. Methods: Eight consecutive patients (six men, two women; mean age, 45.6 years; range, 29 to 70 years) were treated over a period of 38 months for ili ac vein obstruction. Three short bypass procedures between the left il iac vein and the right common iliac vein with temporary arteriovenous fistulas were carried out after an iliofemoral (and caval in two cases ) venous thrombectomy, which revealed May-Thurner syndrome (n = 1) and a compression of the left common iliac vein by the left hypogastric a rtery (n = 2). Five long bypass procedures (one femorofemoral, two lef t common femoral-vena caval, one right superficial femoral-common ilia c, and one bifemorocaval) with a definitive arteriovenous fistula were performed for long chronic venous occlusion in four cases (responsibl e for venous claudication [n = 3], recurrent ulcers in = II) and after iatrogenic ligature of the left external iliac vein during total cyst ectomy with double ureterostomy in one case. Results: There was no evi dence of pulmonary embolism, and no deaths were recorded in the periop erative period. Two patients had an early bypass thrombectomy, but one returned with a further graft occlusion. Seven grafts remained patent after a mean follow-up of 19.5 months (range, 10 to 45 months). One s uccessful thrombectomy was necessary during the twenty-third postopera tive month. Conclusions: Reconstruction of iliac veins in case of perm anent compression, mostly discovered after venous thrombectomy, or for selected patients with symptomatic benign iliac vein occlusion, is sa fe and provides good intermediate-term results.