Hemodynamic significance of collateral blood flow in chronic venous obstruction

Introduction Complaints related to the post-thrombotic syndrome do not always correlate well with the extent of post-thrombotic changes on diagnostic imaging. One explanation might be a difference in development of collateral blood flow. The aim of this study is to investigate the hemodynamic effect of collateralisation in deep venous obstruction. Methodology Resting intravenous pressure of the common femoral vein was measured bilaterally in the supine position of patients with unilateral iliofemoral post-thrombotic obstruction. In addition, pressure in control limbs was also measured in the common femoral vein after sudden balloon occlusion in the external iliac vein. Results Fourteen patients (median age 42 years, 12 female) were tested. In eleven limbs post-thrombotic disease extended below the femoral confluence. Median common femoral vein pressure was 17.0 mmHg in diseased limbs compared to 12.8 mmHg in controls (p = 0.001) and 23.5 mmHg in controls after sudden balloon occlusion (p = 0.009). Results remained significant after correcting for non-occlusive post-thrombotic disease. Conclusion This study shows that common femoral vein pressure is increased in post-thrombotic iliofemoral deep venous obstruction, though not as much as after sudden balloon occlusion. The latter difference could explain the importance of collateralisation in deep venous obstructive disease and the discrepancy between complaints and anatomical changes; notwithstanding, the presence of collaterals does not eliminate the need for treatment.

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Hemodynamic changes in iliofemoral disease

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514529206 ◽

2014 ◽

Vol 29 (1_suppl) ◽

pp. 90-96 ◽

Cited By ~ 5

Author(s):

RLM Kurstjens ◽

MAF de Wolf ◽

R de Graaf ◽

CHA Wittens

Keyword(s):

Femoral Vein ◽

Pressure Measurements ◽

Venous Obstruction ◽

Common Femoral Vein ◽

Thrombotic Disease ◽

Preliminary Results ◽

Need For Treatment ◽

Side Pressure ◽

Control Limb ◽

The Common

Background Iliofemoral venous obstruction, caused by post-thrombotic disease, can be treated by percutaneous angioplasty and additional stenting with good results. However, no hemodynamic parameter determining the need for treatment has been defined. This article describes the preliminary results of a study investigating the pressure changes occurring in post-thrombotic deep venous obstruction. Methodology Four patients with post-thrombotic deep venous obstruction of the iliofemoral tract were identified. Intravenous pressure was pre-operatively measured in the common femoral vein and in a dorsal foot vein bilaterally. During these pressure measurements patients were asked to walk on a treadmill with a speed of 3.2 km/h and a zero per cent slope, with the slope increasing two per cent every two minutes. Results Four patients (two male, two female) with age varying from 23 to 40 were identified. In two patients, disease extended below the femoral confluence. Pressure in the dorsal foot vein was not notably different between the affected and the control side. Pressure in the common femoral vein was markedly higher in post-thrombotic limbs compared to the control limb, with ambulatory pressure increasing more in post-thrombotic limbs. Conclusions These preliminary results are highly illustrative for the hemodynamic effect of iliofemoral deep venous obstruction due to post-thrombotic disease, even though sample size is admittedly limited. Furthermore, these results suggest that pressure measurements of the common femoral vein, and not the dorsal foot vein, might be able to identify a significant outflow obstruction due to post-thrombotic disease, though further inclusion of patients is necessary.

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Endophlebectomy of the Common Femoral Vein and Endovascular Iliac Vein Recanalization for Chronic Iliofemoral Venous Occlusion

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.1147 ◽

2019 ◽

Vol 58 (6) ◽

pp. e476

Author(s):

Mert Dumantepe ◽

Murat Okten ◽

Hasan Karabulut

Keyword(s):

Femoral Vein ◽

Iliac Vein ◽

Venous Occlusion ◽

Common Femoral Vein ◽

The Common

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Endovenectomy of the common femoral vein and intraoperative iliac vein recanalization for chronic iliofemoral venous occlusion

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.02.260 ◽

2010 ◽

Vol 52 (1) ◽

pp. 243-247 ◽

Cited By ~ 39

Author(s):

Anthony J. Comerota ◽

Nina K. Grewal ◽

Subhash Thakur ◽

Zacaria Assi

Keyword(s):

Femoral Vein ◽

Iliac Vein ◽

Venous Occlusion ◽

Common Femoral Vein ◽

The Common

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Endophlebectomy of the common femoral vein and endovascular iliac vein recanalization for chronic iliofemoral venous occlusion

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2019.11.008 ◽

2020 ◽

Vol 8 (4) ◽

pp. 572-582

Author(s):

Mert Dumantepe ◽

Selim Aydin ◽

Murat Ökten ◽

Hasan Karabulut

Keyword(s):

Femoral Vein ◽

Iliac Vein ◽

Venous Occlusion ◽

Common Femoral Vein ◽

The Common

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Stenting in the common femoral vein does not increase posthrombotic syndrome or rethrombosis

European Heart Journal ◽

10.1093/eurheartj/ehab724.2044 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Krause ◽

J M J R Telayna ◽

R A Costantini ◽

J M Telayna

Keyword(s):

Stent Placement ◽

Femoral Vein ◽

Iliac Vein ◽

Female Population ◽

Common Femoral Vein ◽

Group A ◽

The Common ◽

Group B ◽

Venous Stents

Abstract Background In lower limbs deep venous thrombosis (DVT) scenario there is evidence that favours catheter guided invasive treatment. The treatment with stenting in the common femoral vein could be related with a diminished permeability in the inflow of the deep femoral vein. There is scarce data of the clinical follow up of this treatment. Purpose To analize and compare clinical and procedural outcomes in endovenous interventions that required stent placement in the common femoral vein because of residual lesion vs interventions that did no require such treatment. Methods From May 2010 to December 2020, 122 endovenous interventions were performed, within these 74 were DVT compromising the iliofemoral territory. Two groups were defined: Group A 28 (38%) that required stent placement in the common femoral vein and Group B 46 (62%) that did not required such treatment. Results Baseline characteristics were Group A vs Group B n (%) respectively: Median age 41.1±16.7 vs 40.5±18.8; female 23 (82) vs 27 (58); smoking 7 (25) vs 14 (30); cancer 1 (4) vs 7 (15); prior prolonged rest 7 (25) vs 14 (30); concomitant diagnosis of pulmonary embolism 7 (25) vs 17 (37). Within the female population 2 (7) vs 1 (2) were in puerperium; 6 (21) vs 6 (13) were under contraceptive therapy. Regarding the diagnosis of DVT 21 (75) vs 37 (80) were acute; 7 (25) vs 9 (19) were chronic. Compromised vessels were primitive iliac vein 21 (75) vs 38 (82); external iliac vein 6 (21) vs 18 (39); superficial femoral vein 11 (39) vs 8 (17); May-Thurner syndrome 14 (50) vs 20 (43). As regards the aspects of the intervention 15 (53) vs 34 (74) had a filter implanted in the inferior vena cava; thrombolytics were infused in 20 (71) vs 32 (70); manual thrombectomy was performed in 8 (27) vs 17 (37); mechanical thrombectomy 11 (39) vs 19 (41); pre dilation with balloon was performed in 22 (79) vs 39 (85); dedicated venous stents were implanted in 22 (78) vs 39 (85); not dedicated venous stents in 13 (46) vs 11 (24). Technique success was achieved in 28 (100) vs 45 (98) p=1; major bleeding occurred 0 vs 2 (4) p=0.5; rethrombosis 3 (10) vs 9 (20) p=0.25; intrahospital death 1 (4) vs 2 (4) p=1; early reintervention was needed 1 (4) vs 2 (4) p=1, radiation dose (min) 35.4±20.2 vs 30.1±17.0 p=0.2; Contrast (ml) 216.5±76.8 vs 217.3±90.8 p=0.9. During follow up (34.1±31.5 vs 22.3±16.4) image control was performed in 27 (96) vs 39 (85) p=0.23 with either doppler or chest computed tomography angiography. Post thrombotic syndrome (PTS) symptoms were classified with Villalta Score assuming that 0–4 points had no PTS, 5–9 points presented mild PTS, 10–14 points moderate PTS, >14 points severe PTS, in Group A 1 (4) presented mild PTS vs Group B 2 (4) mild PTS p=1, 1 (2) moderate PTS. Conclusions Endovenous treatment with stent placement in the common femoral vein did not required more reinterventions nor had more complications nor had more PTS that the interventions without stent placement. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Basal Characteristics Table 2. Outcomes

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Salvage of a dialysis angioaccess by bypassing a central venous obstruction to the common femoral vein

VASA ◽

10.1024/0301-1526.38.3.245 ◽

2009 ◽

Vol 38 (3) ◽

pp. 245-248 ◽

Cited By ~ 1

Author(s):

Asciutto ◽

Mumme ◽

Asciutto ◽

Geier

Keyword(s):

Upper Extremity ◽

Femoral Vein ◽

Postoperative Recovery ◽

Venous Hypertension ◽

Venous Obstruction ◽

Central Venous ◽

Venous Bypass ◽

Common Femoral Vein ◽

The Common ◽

Central Venous Obstruction

We describe the case of a 71 year-old male patient undergoing haemodialysis who presented with severe symptoms of venous hypertension at the left upper extremity due to subclavian and innominate vein obstruction. The patient had a well functioning ispilateral angioaccess. The pain and disabling swelling of the upper extremity developed 12 months after having a radio-cephalic arteriovenous fistula performed and progressively worsened in the last two months. The patient underwent extraanatomic axillo-femoral venous bypass grafting with a 8 mm polytetrafluoroethylene graft to the ispilateral common femoral vein. The postoperative recovery was regular and the patient was discharged 6 days after surgery with a functioning bypass and relief from the venous hypertension symptoms. In this case, surgical bypassing of a central venous obstruction through an extra-anatomical pathway relieved the symptoms of venous hypertension and prolonged the use of the haemodialysis access.

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