Iliac venous obstruction: Surgical reconstruction

Aim: To review the investigation and treatment of iliac vein obstruction. Method: A review of current literature in the field of management of iliac venous obstruction has been conducted. Synthesis: Iliac venous obstruction results in chronic or acute symptoms in the lower limb presenting as pain, swelling, oedema and discomfort of the lower limb. Intrinsic or extrinsic obstruction of the iliac veins may be th e cause. Cockett syndrome is the classic aetiology for chronic intermittent or fixed left inferior limb venous obstruction. Other causes include tumou rs, vascular grafts or lymph node compression and retroperitoneal fibrosis. Duplex ultrasound imaging is now the first-choice investigation. CT scanni ng is useful where external vein compression is suspected. Phlebography is used when an endovascular procedure is to be done. The surgical treatment o f Cockett syndrome described by Cormier is transposition of the common righ t iliac artery in the left internal iliac artery. This is being replaced by endovascular balloon venoplasty completed by stenting of the left iliac ve in. We reviewed the experience of surgical correction of Cockett syndrome w ith Cormier's technique in 70 patients operated on between 1976 and 1990; 5 5 patients had a follow-up of 12-177 months. Anatomical and functional resu lts were perfect for all patients except when endoluminal synechiae or ilia c venous thrombosis were associated with postural compression. In this case a 50% success rate was achieved. The endovascular revolution offers a less invasive technique for treatment of chronic iliac venous obstruction. Foll ow-up is short at present in the few publications found in the literature. Conclusions: Iliac vein obstruction results in symptoms of swelling in the lower limbs. These may be managed conservatively. Where there is an indicat ion for venous reconstruction, investigation by duplex ultrasonography is t he first step. Endovascular procedures including stenting offer significant benefit. The long-term outcome of these interventions has yet to be establ ished.