Complex venous reconstruction for chronic iliofemoral vein obstruction

A 35-year-old patient, physically very active, developed symptoms and signs of postphlebitic venous obstruction in the right lower extremity that was complicated by deep venous thrombosis, while recovering from a motorcycle accident. Duplex and venography demonstrated occlusion of the right superficial femoral vein and right external iliac vein. Strain-gauge plethysmography and measurements of venous pressures demonstrated functional obstruction. The patient underwent saphenous cross-femoral vein bypass, right saphenous-popliteal anastomosis accompanied with distal posterior tibial to saphenous vein arteriovenous fistula. Ten days following surgery, the arteriovenous fistula and the distal great saphenous vein closed spontaneously. The rest of the reconstruction remained patent as documented by duplex up to 24 months following the surgery. Clinically, the patient is doing well, tolerating heavy physical exertion as before his accident. The importance of selection of patients for venous bypass surgery is stressed. Only patients with co-existing anatomical and functional obstruction are good candidates for these procedures.