Iliac vein reconstructions to treat acute and chronic venous occlusive disease

The treatment of permanent and benign iliac vein occlusion responsible for acute vein thrombosis or chronic symptoms remains controversial. Different methods of reconstruction using a reinforced expanded polytetrafluoroethylene bypass graft associated with an arteriovenous fistula and their intermediate-term results are analyzed.

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 iliac vein obstruction. Three short bypass procedures between the left iliac 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 artery (n = 2). Five long bypass procedures (one femorofemoral, two left common femoral-vena caval, one right superficial femoral-common iliac, and one bifemorocaval) with a definitive arteriovenous fistula were performed for long chronic venous occlusion in four cases (responsible for venous claudication [n = 3], recurrent ulcers [n = 1] and after iatrogenic ligature of the left external iliac vein during total cystectomy with double ureterostomy in one case.

There was no evidence of pulmonary embolism, and no deaths were recorded in the perioperative 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 successful thrombectomy was necessary during the twenty-third postoperative month.

Reconstruction of iliac veins in case of permanent compression, mostly discovered after venous thrombectomy, or for selected patients with symptomatic benign iliac vein occlusion, is safe and provides good intermediate-term results.