MIXED OBSTRUCTION/REFLUX

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Presentation transcript:

MIXED OBSTRUCTION/REFLUX Stephen F. Daugherty, MD, FACS, FACPh, RVT, RPhS Clarksville, Tennessee

NO RELEVANT DISCLOSURES No stents are yet approved by the FDA for iliac vein treatment.

KEY CONCEPTS RECOGNIZE OBSTRUCTION TREAT ILIOCAVAL- COMMON FEMORAL OBSTRUCTION FIRST AVOID ABLATION OF OUTFLOW PATHWAYS

CLUES LE EDEMA OR PAIN OUT OF THE PROPORTION TO LE US FINDINGS PELVIC PAIN, DEEP DYSPAREUNIA VENOUS CLAUDICATION, esp. THIGH HISTORY OF DVT OF LE APHASIC OR ASYMMETRICAL FLOW AT CFV ABNORMAL COLLATERALS FROM LEG TO PELVIS

Raju and Neglén- JVS, 2006 Non thrombotic iliac vein lesions (NIVL) “has high prevalence and a broad demographic spectrum in patients with CVD.” “Stent placement alone, without correction of associated reflux, often provides relief.” 938 limbs in 879 patients out of 4026 patients with CVD. Similar short-term results whether reflux was treated or not.

CALL FOR A “NEW PARADIGM”- Raju, et al, SVS, 2009 1997-2008 1487 Iliac limbs stented for obstruction 58% Post-thrombotic 42% Compression 513 Deep vein reflux 366 Deep vein and axial vein reflux

CALL FOR A “NEW PARADIGM”- Raju, et al SVS, 2009 Relief of Pain - 83% Complete 89% Significant Relief of Swelling - 46% Complete 71% Significant Freedom from Ulcer at 5 years- 63%

FLOW VOLUMES

SUGGEST OBSTRUCTION DFV > FV GSV > FV

PRIORITIES TREAT ILIOCAVAL/COMMON FEMORAL OBSTRUCTION TREAT MAJOR SUPERFICIAL VEIN REFLUX ASSESS OUTFLOW PATHWAYS BEFORE ABLATION