Peripheral Vascular Surgery Society

#11 FEMORAL-CAVAL BYPASS FOR ILIAC VEIN OBSTRUCTION USING SUPERFICIAL FEMORAL VEIN.

Tina R. Desai, MD, Shari L. Meyerson, MD, and Hisham S. Bassiouny, MD

The University of Chicago, Chicago, IL.

Optimal management for chronic occlusion of the iliofemoral venous system remains controversial. While early reports document successful large vein reconstructions with prosthetic conduits, such techniques have been associated with a high rate of graft thrombosis. Recent enthusiasm for superficial femoral vein (SFV) as an autologous conduit in arterial reconstruction encouraged us to utilize SFV for reconstruction of a symptomatic chronically occluded iliac venous system.

CASE REPORT: A 55-year-old Caucasian male presented with a three-year history of right lower extremity recurrent deep venous thrombosis. Despite chronic warfarin therapy, he developed incapacitating chronic right leg edema and severe venous claudication. Ascending venography revealed occlusion of the right superficial femoral, common femoral, and iliac veins with a patent greater saphenous vein draining the infrageniculate deep venous system and communicating with the inferior vena cava via large collaterals. All deep and superficial veins of the left lower extremity were patent. The patient underwent a right saphenofemoral junction to inferior vena cava bypass using the left SFV. He was maintained on anticoagulation with intravenous heparin perioperatively and oral warfarin was resumed. His symptoms significantly improved with marked reduction of edema and improvement in walking distance. Magnetic resonance venography at three months postoperatively and venous duplex evaluation at 6 months and 12 months postoperatively have demonstrated a patent femoral caval bypass graft.

The SFV has successfully served as a conduit for arterial reconstruction in a variety of locations, but has not heretofore been described in venous reconstructions. The appropriate size and minimal morbidity from harvest render it an ideal conduit for large venous reconstructions. In properly selected patients with chronic iliofemoral venous occlusion, SFV venous bypass should be considered to relieve the morbid sequelae of venous hypertension.

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Last updated January 1,2000