Pysiological Evaluation of Venous Obstruction in the Post-Thrombotic Leg

1989 ◽  
Vol 4 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Henrik Åkesson ◽  
Lars Brudin ◽  
Ragnar Jensen ◽  
Per Ohlin ◽  
Gunnar Plate
Keyword(s):  
Clinical Symptoms ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Reference Method ◽  
Iliac Vein ◽  
Venous Obstruction ◽  
Venous Outflow ◽  
Physiological Importance ◽  
Venous Outflow Obstruction ◽  
Additional Value

The accuracy and value of occlusion plethysmography (OP) in assessing post-thrombotic iliac and femoral vein obstruction was determined in 45 patients (85 legs) six months after an acute iliofemoral venous thromboses using contrast phlebography (CP) as reference method. The additional value of femoral venous pressure (FVP) measurements in assessing the physiological importance of iliac vein obstructions was determined in 34 of these patients (60 legs). The sensitivity and specificity of OP in detecting femoral and iliac vein obstructions was 79% and 84% respectively. OP was unable to distinguish femoral from iliac lesions and stenosis from obstructions. A maximum venous outflow (MVO) <30 ml·100 ml−1 ·min−1 was greatly associated with venous obstruction which was very uncommon if the MVO >50 ml·100 ml−1 ·min−1. Resting FVPs were of little value in assessing iliac venous outflow. Exercise pressures and comparison with normal contralateral veins improved the association with anatomical obstruction. A difference in FVP change with exercise exceeding l mmHg as compared to the contralateral leg was most predictive of an iliac vein obstruction. Patients with obvious clinical symptoms of venous outflow obstruction (venous claudication) all had iliac vein obstruction, abnormal OP and an FVP change with exercise exceeding 5 mmHg. This demonstrates the ability of OP and FVP to reflect physiological rather than morphological post-thrombotic venous obstruction.

Chronic Venous Obstruction: Diagnostic Considerations and Therapeutic Role of Percutaneous Iliac Stenting

Vascular ◽  
2007 ◽  
Vol 15 (5) ◽  
pp. 273-280 ◽  
Author(s):  
Peter Neglén
Keyword(s):  
Clinical Signs ◽  
Venous Obstruction ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Therapeutic Role ◽  
Venous Stenting ◽  
Chronic Venous Obstruction ◽  
Venous Outflow Obstruction ◽  
Diagnostic Modalities

Iliac venous outflow obstruction has an important role in the expression of symptomatic chronic venous insufficiency. This anatomic obstruction is frequently overlooked, owing in part to diagnostic difficulty. The combination of venous obstruction and reflux leads to more severe clinical disease. Current diagnostic modalities do not allow an definitive assessment of hemodynamically critical venous obstruction. No single invasive or noninvasive study can accurately detect borderline obstruction of potential hemodynamic significance. A high index of suspicion is critical in the initial recognition of chronic venous obstruction. The diagnosis relies on clinical signs and symptoms and radiologic assessment of morphologic venous outflow obstruction. Treatment strategy should be based on the results of morphologic investigations such as transfemoral phlebography or, preferably, intravascular ultrasonography. Percutaneous iliac venous stenting offers a safe and efficient method to correct pelvic venous obstruction. Percutaneous iliac stenting does not preclude subsequent venous bypass or corrective superficial and deep reflux surgery. This article reviews the etiologic factors and diagnostic modalities of iliac venous obstruction. The therapeutic role of percutaneous iliac stenting in the management of venous obstruction is also discussed.

Secondary interventions after iliac vein stenting for chronic proximal venous outflow obstruction

2019 ◽  
Vol 7 (5) ◽  
pp. 670-676
Author(s):  
Aiya Aboubakr ◽  
Jesse Chait ◽  
Jacob Lurie ◽  
Harry R. Schanzer ◽  
Michael L. Marin ◽  
...  
Keyword(s):  
Iliac Vein ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Secondary Interventions ◽  
Venous Outflow Obstruction

Secondary Interventions After Iliac Vein Stenting for Chronic Proximal Venous Outflow Obstruction

2017 ◽  
Vol 5 (1) ◽  
pp. 150
Author(s):  
Aiya Aboubakr ◽  
Joshua Lee ◽  
Harry Schanzer ◽  
Michael Marin ◽  
Peter Faries ◽  
...  
Keyword(s):  
Iliac Vein ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Secondary Interventions ◽  
Venous Outflow Obstruction

Hemodynamic significance of collateral blood flow in chronic venous obstruction

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 27-34 ◽  
Author(s):  
RLM Kurstjens ◽  
MAF de Wolf ◽  
JHH van Laanen ◽  
MW de Haan ◽  
CHA Wittens ◽  
...  
Keyword(s):  
Blood Flow ◽  
Femoral Vein ◽  
Iliac Vein ◽  
Balloon Occlusion ◽  
Collateral Blood Flow ◽  
Venous Obstruction ◽  
Common Femoral Vein ◽  
Thrombotic Disease ◽  
Need For Treatment ◽  
The Common

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.

Managing Chronic Iliac Venous Occlusions That Extend Below the Inguinal Ligament

2018 ◽  
Author(s):  
Roshni A. Parikh ◽  
David M. Williams
Keyword(s):  
Quality Of Life ◽  
Saphenous Vein ◽  
Femoral Vein ◽  
Inguinal Ligament ◽  
Venous Obstruction ◽  
Venous Outflow ◽  
Saphenofemoral Junction

This chapter describes the management, applications, challenges, and potential complications when venous occlusions extend below the inguinal ligament. Recanalization of a chronic iliocaval occlusion in combination with anticoagulation can significantly improve a patient’s quality of life. The success of treating iliocaval venous obstruction, however, depends on good venous inflow. Without adequate venous inflow, the outflow stents will fail. Evaluation of the saphenofemoral junction, femoral vein confluence, and/or saphenous vein, recanalization of the occluded segments, and extension of the stents will improve the venous inflow. This chapter describes the steps involved in the evaluation of both venous outflow and venous inflow and the establishment of flow throughout.

The role of venous sinus outflow obstruction in pediatric idiopathic intracranial hypertension

2013 ◽  
Vol 11 (2) ◽  
pp. 144-149 ◽  
Author(s):  
Christopher M. Dwyer ◽  
Kristina Prelog ◽  
Brian K. Owler
Keyword(s):  
Collateral Circulation ◽  
Venous Sinus ◽  
Control Group ◽  
Venous Obstruction ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Significant Difference ◽  
Venous Outflow Obstruction ◽  
And Control

Object The authors examined the role of venous sinus obstruction in the etiology of idiopathic intracranial hypertension (IIH) by reviewing more than 200 MR venograms performed in suspected cases of IIH. Methods Individual MR venograms performed in cases of suspected IIH at the Children's Hospital at Westmead in Sydney, Australia, were reviewed. The authors excluded cases in which an intervention was performed before the scan or a structural cause for venous obstruction was identified. Cases with confirmed hydrocephalus were also excluded. For each of the 145 remaining scans, the authors completed a detailed review on a slice-by-slice basis of the 2D source images used to compile the rendered 3D MR venogram. The anatomical configuration of the dural venous sinuses and any areas of decreased flow in circulation were then noted. Where possible, they correlated their radiological findings with evidence of raised intracranial pressure based on LP opening pressures. They also reviewed a control group of 50 MR venograms. Results Seventy-six (52%) of 145 scans showed evidence of venous obstruction in the dominant-side circulation. Substantial nonphysiological collateral circulation was seen in 68% of cases with dominant-sided obstruction, suggesting a process of recanalization. In contrast, in the absence of dominant-sided obstruction, collateral circulation was uncommon. In 27 cases, CSF opening pressure measurements were available. In 20 cases the opening pressures were in excess of 20 cm H2O. Of those, 17 demonstrated evidence of dominant-sided venous outflow obstruction. Among those cases, the median opening pressure was 34 cm H2O. Dominant-sided venous outflow obstruction was seen in only 2 of 50 MR venograms in the control group. Furthermore, evidence of collateral circulation was also uncommon in the control group. There was a highly statistically significant difference between rates of dominant-sided venous obstruction in the suspected IIH and control groups (p ≤ 0.001). Conclusions A majority of patients presenting for investigation of suspected IIH demonstrated evidence of dominant-sided venous obstruction on MR venogram. In addition there was a high correlation between elevated CSF opening pressures and dominant-sided venous sinus obstruction. This correlation was further supported by evidence of collateral recanalization in patients with elevated CSF pressures and dominant-sided venous obstruction. A control group of 50 MR venograms indicated that dominant-sided venous outflow obstruction is an unlikely incidental finding, and a highly statistically significant difference was found between rates of obstruction in the suspected IIH and control groups.

scholarly journals Episcleral venous pressure level in patients with thyroid associated orbitopathy

2018 ◽  
Vol 11 (3) ◽  
pp. 21-25
Author(s):  
Vitaly V. Potemkin ◽  
Elena V. Goltsman ◽  
Maria S. Kovaleva
Keyword(s):  
Venous Pressure ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Precise Data ◽  
Episcleral Venous Pressure ◽  
Venous Compression ◽  
Main Index ◽  
Venous Outflow Obstruction ◽  
Temporal Quadrant ◽  
Severity Of The Disease

Thyroid associated orbitopathy (TAO) occurs in patients with various diseases of the thyroid gland. The levels of episcleral venous pressure (EVP), intraocular pressure and intraorbital pressure are inter- related. There are no precise data on the change of EVP in patients with TAO. Purpose. To evaluate EVP in patients with compensated and sub-compensated TAO forms. Methods. Data of 41 eyes of 22 patients were enrolled into the study. The main index to be evaluated was the EVP. Results. EVP level was significantly higher in complete venous compression in the lower- temporal quadrant in patients with sub-compensated TAO stage (p = 0.013). Conclusion. The degree of venous outflow obstruction and the EVP level of are interrelated. Thus, the level of EVP can be used as an additional factor in assessing the severity of the disease course and the treatment efficacy.

Standards for recanalisation of chronic venous outflow obstructions

VASA ◽  
2018 ◽  
Vol 47 (4) ◽  
pp. 259-266 ◽  
Author(s):  
Michael Lichtenberg ◽  
Rick de Graaf ◽  
Christian Erbel
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Symptoms ◽  
Vena Cava ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Postthrombotic Syndrome ◽  
Venous Outflow ◽  
Vein Thrombosis ◽  
Technical Developments ◽  
Deep Vein

Abstract. Postthrombotic syndrome (PTS) is the most common complication after iliofemoral deep vein thrombosis. It reduces quality of life and increases deep vein thrombosis (DVT)-related costs. The clinical symptoms and severity of PTS may vary; the most common symptoms include edema, pain (venous claudication), hyperpigmentation, lipodermatosclerosis, and ulceration. PTS is based on the principle of outflow obstruction, which may be caused by venous hypertension and may lead to valvular damage and venous reflux or insufficiency. Recent technical developments and new stent techniques now allow recanalisation of even complex venous outflow obstructions within the iliac vein and the inferior vena cava. This manuscript gives an overview on the latest standards for venous recanalisation.

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