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

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.

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

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.10.peds1299 ◽

2013 ◽

Vol 11 (2) ◽

pp. 144-149 ◽

Cited By ~ 19

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.

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Venous Stenting in Proximal Venous Outflow Obstruction: Outcome Predictors

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2017.12.021 ◽

2018 ◽

Vol 6 (2) ◽

pp. 286

Author(s):

Windsor Ting ◽

Anthony Yang ◽

Chuma Nwachukwu ◽

Aisosa Omorogbe ◽

Paul Lajos ◽

...

Keyword(s):

Outcome Predictors ◽

Outflow Obstruction ◽

Venous Outflow ◽

Venous Stenting ◽

Venous Outflow Obstruction

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The Role of Venous Outflow Obstruction in Patients With Chronic Venous Dysfunction

Archives of Surgery ◽

10.1001/archsurg.1997.01430250048011 ◽

1997 ◽

Vol 132 (1) ◽

pp. 46 ◽

Cited By ~ 76

Author(s):

Nicos Labropoulos

Keyword(s):

Outflow Obstruction ◽

Venous Outflow ◽

Venous Outflow Obstruction

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Risk Factors for Hepatic Venous Outflow Obstruction in Piggyback Liver Transplantation: The Role of Recipient’s Pattern of Hepatic Veins Drainage into the Inferior Vena Cava

Annals of Transplantation ◽

10.12659/aot.902753 ◽

2017 ◽

Vol 22 ◽

pp. 303-308 ◽

Cited By ~ 2

Author(s):

Qifa Ye ◽

Cheng Zeng ◽

Yanfeng Wang ◽

Zhehong Fang ◽

Xiaoyan Hu ◽

...

Keyword(s):

Risk Factors ◽

Inferior Vena ◽

Vena Cava ◽

Hepatic Veins ◽

Outflow Obstruction ◽

Venous Outflow ◽

Hepatic Venous Outflow Obstruction ◽

Hepatic Venous Outflow ◽

Venous Outflow Obstruction

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Diagnosis and treatment of chronic venous obstruction: consensus statement of the Russian experts (part 2)

Hirurg (Surgeon) ◽

10.33920/med-15-2004-02 ◽

2020 ◽

pp. 22-55

Author(s):

K.V. Lobastov ◽

D.V. Bondarchuk ◽

D.A. Borsuk ◽

R.A. Bredikhin ◽

O.V. Bukina ◽

...

Keyword(s):

Consensus Statement ◽

Relevant Literature ◽

Clinical Manifestations ◽

Duplex Ultrasound ◽

Diagnosis And Treatment ◽

Ultrasound Scan ◽

Venous Obstruction ◽

Venous Stenting ◽

Chronic Venous Obstruction

This consensus statement of Russian experts is based on a review of the relevant literature on the prevalence, diagnosis, and treatment of non-thrombotic and post-thrombotic venous obstruction, as well as management of patients after venous stenting. In the Part 1 we discussed the clinical manifestations of venous obstruction, the role of duplex ultrasound scan, CT venography, MR venography, direct venography, and intravascular ultrasound scan, as well as typical findings obtained by using these methods. The authors mentioned the functional assessment of venous outflow in healthy subjects and in those with obstruction and changes in them after the intervention. In conclusion, the authors formulated the suggestions for clinical recommendations on the diagnosis of chronic venous obstruction.

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