Chap 61-62 Iliocaval Occlusion Flashcards Preview

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Flashcards in Chap 61-62 Iliocaval Occlusion Deck (32):
1

Name causes of venous occlusion.

trauma
radiation
tumor
cyst
aneurysm
abnormally inserted muscle
compression by CIA
congenital anomalie
(budd-chiari, KTS)

2

What is perthes test?

Touriniquet prox calf, walk patient (rapid emptying of superficial vein through perforators and deep system)
Distention of superficial veins distal to tourniquet after walking indicates deep venous occlusion

3

What are test for deep venous occlusion?

duplexy and plethysmography to confirm
CT/MR to rule out other causes

4

What are conduits for venous bypass?

SVG
contrs SFV
basillic-brachial ax vein
ePTFE for large veins

5

What is the advantage of an AVF for a prosthetic venous bypass?

improves patency
decreases pot and fibrin deposition
increases flow

6

What are the disadvantages of an AVF?

longer OR time
redo to close
elevated CO
increase venous pressure in groin

7

What are the indications for AVF?

all femeral vein anastomosis
all iliocaval >10cm

8

How long to leave open?

6 months but longer if tolerated

9

What is surveillance of an AVF?

intraop <300ml/min
POD1 contrast phlebography
duplex at 3-6 months

10

What is the management strategy for symptomatic venous obstruction?

conservative
endovascular +/- thrombo
surgical thrombectomy
surgical bypass

11

Describe a saphenopopliteal bypass. where do you do the AVF? how many people get improvement?

occlusion of fem or prox pop
SVG to pop
temp AVF at ankle (PTA/PTV)
80% improvement

12

Describe the palma procedure. how many people improve?

cross pubic venous bypass for unilateral iliac vein obstruction
need SVG 5 or > or prosthetic
can use AVF
80% improvement

13

Describe a prosthetic femorocaval, iliocaval or IVC bypass.

in-lin iliac/iliocaval reconstruction
expose fem vessels for AVF (do first)
primary patency 65% at 5 years

14

What is may-thurner syndrome?

compression of L iliac vein b/w R CIA and 5th lumbar vertebra

15

Who get may-thurner?

women 2-4th decades

16

what are symptoms of May-thurner?

left leg swelling, venous claudication, pain, skin changes, rare ulceration
acute comp left iliofem dvt—rare

17

What is treatment for MT?

surgical for symptom
endo option no LT outcomes

stenting of iliac, failed then palma
80% improvement post-op

18

What is most common indication for suprarenal IVC reconstruction?

membranous occlusion of the IVC

19

What are conduits used for reconstruction of suprarenal IVC?

spiral vein graft
SFV
ePTFE

20

What is pelvic-renal congestion syndrome?

dilated pelvic veins
stretch causes pain
can cause urinary symptoms

21

Who gets PCS? what are symptoms?

usually child-bearing aged women
pelvic pain >6 month
heaviness relieved with lying down
dyspareunia, dysuria, contipation
R>L

22

What is workup for PCS?

abdo tenderness on pal and hx pain after sex high sensitivity

duplex
PPV high if ovarian vein >6mm

CTV/MRV

Phleobography

23

What are findings for PCS on phlebography?

ovarian vein >5mm
retention of contrast >2secs
congestion in pelvic venous plexus
opacification of internal iliac vein

24

What is tx for PCS?

progesterone for 6 months
surgery
ovarian/internal vein/artery ligation
oopherectomy/total hyst

endovascular
coil embo
foam

SVS
coil embo, plugs, sclerotherpay

25

What is nutcracker syndrome?

Compression of distal segment of LRV b/w SMA and aorta

26

What are mechanism of LRV compression?

acute angle of SMA
posterior ptosis of left kidney
high course of LRV

27

What are symptoms

Left flank pain radiating to buttock
hematuria
aggravated by standing

28

What are findings on duplex?

signif stenosis if diameter on left side of aorta 5x greater tena at level of stenosis
PV at stenosis 5x PV measured at hilum
collaterals

29

What are other investigations for nutcracker?

reno-caval gradient 3mmHG or higher
CTA/MRA (LRV compression)
phlebography

30

Who to treat and how?

severe symptomatic
endovascular
stenting
surgery
reimplant lrv into IVC
renal autotransplantation
LRV bypass

31

What are some consideration for stunting in venous system?

POBA insufficient needs stent
kissing technique unessecary
redilate after stent insertion
can be placed across inguinal ligament
do not leave skip areas
vein can accept extensive dilatation

32

How to avoid stent migration?

use long stent