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Surgical femorocaval bypass for treating chronic iliac vein occlusion: a case report
Qingzhi Hao1, Ruiping Ma2, Yanmeng Kang3
1Department of Peripheral Vascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan 250011, P. R. China.
Insights
Venous bypass surgery is a viable option for chronic vein occlusion when endovascular therapy fails. Proper surgical technique, including stoma and fistula design, ensures successful outcomes and long-term vein patency.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic occlusion of the inferior vena cava and iliac veins, often due to deep venous thrombosis, causes significant morbidity including limb swelling, venous claudication, and ulcers.
- Conservative treatments are frequently ineffective for severe venous occlusive disease.
- Endovascular therapy offers a less invasive approach with high success rates but is not always suitable or successful.
Observation:
- A patient with chronic deep venous thrombosis and occlusion of the bilateral iliac veins and distal inferior vena cava underwent attempted interventional therapy, which unfortunately failed.
- Following the failure of endovascular treatment, the patient was treated with femorocaval bypass, with careful attention to the design of the anastomotic stoma and orificium fistulae.
Findings:
- The femorocaval bypass procedure, utilizing a rational design for the anastomotic stoma and orificium fistulae, resulted in significant clinical improvement.
- Twelve-month follow-up demonstrated successful relief of limb swelling and complete healing of intractable ulcers.
Implications:
- This case highlights the critical role of meticulous surgical planning and execution in venous bypass for complex venous occlusive disease.
- Rational anastomotic stoma and orificium fistulae design can ensure the clinical efficacy and long-term patency of venous bypass, offering a valuable alternative when endovascular methods fail.
Abstract:
Chronic inferior vena cava and iliac vein occlusion, caused by long-term of deep venous thrombosis, will lead to swelling of the limbs, venous claudication and intractable ulcer. However, conservative treatment is often ineffective for vein occlusion. With the development of interventional techniques, endovascular therapy has become the first choice for the treatment of vein occlusion with higher success rate and lower trauma. However, for cases those fail endovascular therapy or for segmental veno-occlusive diseases with low long-term patency rate, venous bypass might be the only option. And, design of anastomotic stoma and orificium fistulae design is crucial to the success of operation. A case of long term deep venous thrombosis patient with occlusion in bilateral iliac vein and distal inferior vena cava was admitted and treated with interventional therapy. Unfortunately, this method failed. Then, we selected reasonable anastomotic stoma and orificium fistulae and performed femorocaval bypass. The 12 month follow-up results showed that the swelling was successively relieved and the ulcer healed. This indicated that rational anastomotic stoma and orificium fistulae could guarantee the exact clinical efficacy of venous bypass and higher long-term patency rate.
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