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

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

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

4. 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

5. 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.

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

7. 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%

13. FLOW VOLUMES

14. SUGGEST OBSTRUCTION
DFV > FV
GSV > FV

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