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Venous Disease > Iliocaval Occlusion > Flashcards

Iliocaval Occlusion Flashcards

1
Q
A
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2
Q

Name causes of venous occlusion.

A

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

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3
Q

What is perthes test?

A

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

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4
Q

What are test for deep venous occlusion?

A

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

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5
Q

What are conduits for venous bypass?

A

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

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6
Q

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

A

improves patency
decreases pot and fibrin deposition
increases flow

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7
Q

What are the disadvantages of an AVF?

A

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

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8
Q

What are the indications for AVF?

A

all femeral vein anastomosis
all iliocaval >10cm

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9
Q

How long to leave open?

A

6 months but longer if tolerated

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10
Q

What is surveillance of an AVF?

A

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

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11
Q

What is the management strategy for symptomatic venous obstruction?

A

conservative
endovascular +/- thrombo
surgical thrombectomy
surgical bypass

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12
Q

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

A

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

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13
Q

Describe the palma procedure. how many people improve?

A

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

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14
Q

Describe a prosthetic femorocaval, iliocaval or IVC bypass.

A

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

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15
Q

What is may-thurner syndrome?

A

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

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16
Q

Who get may-thurner?

A

women 2-4th decades

17
Q

what are symptoms of May-thurner?

A

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

18
Q

What is treatment for MT?

A

surgical for symptom
endo option no LT outcomes

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

19
Q

What is most common indication for suprarenal IVC reconstruction?

A

membranous occlusion of the IVC

20
Q

What are conduits used for reconstruction of suprarenal IVC?

A

spiral vein graft
SFV
ePTFE

21
Q

What is pelvic-renal congestion syndrome?

A

dilated pelvic veins
stretch causes pain
can cause urinary symptoms

22
Q

Who gets PCS? what are symptoms?

A

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

23
Q

What is workup for PCS?

A

abdo tenderness on pal and hx pain after sex high sensitivity

duplex
PPV high if ovarian vein >6mm

CTV/MRV

Phleobography

24
Q

What are findings for PCS on phlebography?

A

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

25
Q

What is tx for PCS?

A

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

endovascular
coil embo
foam

SVS
coil embo, plugs, sclerotherpay

26
Q

What is nutcracker syndrome?

A

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

27
Q

What are mechanism of LRV compression?

A

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

28
Q

What are symptoms

A

Left flank pain radiating to buttock
hematuria
aggravated by standing

29
Q

What are findings on duplex?

A

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

30
Q

What are other investigations for nutcracker?

A

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

31
Q

Who to treat and how?

A

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

32
Q

What are some consideration for stunting in venous system?

A

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

33
Q

How to avoid stent migration?

A

use long stent

Venous Disease (6 decks)

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