Flashcards in Chap 61-62 Iliocaval Occlusion Deck (32):
Name causes of venous occlusion.
abnormally inserted muscle
compression by CIA
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
What are test for deep venous occlusion?
duplexy and plethysmography to confirm
CT/MR to rule out other causes
What are conduits for venous bypass?
basillic-brachial ax vein
ePTFE for large veins
What is the advantage of an AVF for a prosthetic venous bypass?
decreases pot and fibrin deposition
What are the disadvantages of an AVF?
longer OR time
redo to close
increase venous pressure in groin
What are the indications for AVF?
all femeral vein anastomosis
all iliocaval >10cm
How long to leave open?
6 months but longer if tolerated
What is surveillance of an AVF?
POD1 contrast phlebography
duplex at 3-6 months
What is the management strategy for symptomatic venous obstruction?
endovascular +/- thrombo
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)
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
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
What is may-thurner syndrome?
compression of L iliac vein b/w R CIA and 5th lumbar vertebra
Who get may-thurner?
women 2-4th decades
what are symptoms of May-thurner?
left leg swelling, venous claudication, pain, skin changes, rare ulceration
acute comp left iliofem dvt—rare
What is treatment for MT?
surgical for symptom
endo option no LT outcomes
stenting of iliac, failed then palma
80% improvement post-op
What is most common indication for suprarenal IVC reconstruction?
membranous occlusion of the IVC
What are conduits used for reconstruction of suprarenal IVC?
spiral vein graft
What is pelvic-renal congestion syndrome?
dilated pelvic veins
stretch causes pain
can cause urinary symptoms
Who gets PCS? what are symptoms?
usually child-bearing aged women
pelvic pain >6 month
heaviness relieved with lying down
dyspareunia, dysuria, contipation
What is workup for PCS?
abdo tenderness on pal and hx pain after sex high sensitivity
PPV high if ovarian vein >6mm
What are findings for PCS on phlebography?
ovarian vein >5mm
retention of contrast >2secs
congestion in pelvic venous plexus
opacification of internal iliac vein
What is tx for PCS?
progesterone for 6 months
ovarian/internal vein/artery ligation
coil embo, plugs, sclerotherpay
What is nutcracker syndrome?
Compression of distal segment of LRV b/w SMA and aorta
What are mechanism of LRV compression?
acute angle of SMA
posterior ptosis of left kidney
high course of LRV
What are symptoms
Left flank pain radiating to buttock
aggravated by standing
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
What are other investigations for nutcracker?
reno-caval gradient 3mmHG or higher
CTA/MRA (LRV compression)
Who to treat and how?
reimplant lrv into IVC
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