Peripheral Vascular Surgery Society

#10 CRYOPRESERVED SUPERFICIAL FEMORAL VEIN BYPASS FOR REFRACTORY PELVIC VENOUS OUTFLOW OBSTRUCTION.

E. John Harris, Jr., MD

Stanford University School of Medicine, Stanford, CA

Chronic iliac vein obstruction is found in 10-15% of patients with chronic venous insufficiency. The vast majority of these patients are post-thrombotic with antecedent history of deep vein thrombosis involving the ilio-femoral segment, and persistent symptoms of leg edema and pain despite long term anticoagulation. A 39-year-old male presented with a 14-year history of progressive right leg venous claudication. The patient had a history of retroperitoneal germ cell carcinoma, treated initially with chemo- and radiation therapy, followed by retroperitoneal tumor resection. Postoperatively, an ipsilateral iliofemoral deep vein thrombosis was diagnosed. Initial treatment with heparin was complicated by a retroperitoneal bleed, and a vena caval filter was placed. Anticoagulation was re-initiated 5 days later, but the patient stopped warfarin 3 months later, against medical advice. Progressive symptoms of thigh swelling and exercise intolerance led to referral, where venous duplex identified iliac venous obstruction but patent popliteal and femoral segments, findings confirmed by venography. Iliofemoral balloon venoplasty and stenting with wallstents was achieved with initial symptomatic relief, yet re-thrombosis occurred 3 weeks later despite therapeutic warfarin anticoagulation. Follow-up venography showed the thrombosed stents extended to the vena caval filter, which was infrarenal and patent. Following informed consent, two segments of 14-mm cryopreserved human superficial femoral veins were anastamosed end-to-end and used for in-line iliocaval reconstruction. A retroperitoneal approach exposed the para-renal vena cava, and the common femoral vein was exposed with a groin incision. End-to-side anastomoses with interrupted sutures were created at the common femoral and vena caval targets for the retroperitoneally tunneled 25-cm segment of cryopreserved vein. No arterial-venous fistula was employed. Phasic outflow from the lower limb was re-established, venous claudication resolved and serial follow-up venous duplex studies have confirmed intermediate term patency of the bypass graft.

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Last updated January 1,2000