title: Complex left profunda femoris vein to renal vein bypass for the management of progressive chronic iliofemoral occlusion.
abstract: Chronic occlusions of the inferior vena cava (IVC) and iliofemoral veins are long-term sequelae of deep venous thrombosis (DVT) that can lead to postthrombotic syndrome (PTS). Patients may present with a wide spectrum of signs and symptoms, ranging from mild discomfort and swelling to severe venous hypertension and ulcerations. We report a 68-year-old man who had a history of left lower extremity DVT after a laminectomy and who developed PTS with nonhealing ulcers. The patient underwent a cross-pubic femorofemoral venous bypass that failed to improve his clinical status. After unsuccessful endovascular attempts for recanalization of the iliofemoral segment, a profunda femoris to IVC bypass was performed. The symptoms recurred 2 years later. Venography revealed restenosis at the caval anastomosis that did not resolve by endovascular means. A surgical revision was performed, and given the quality of the IVC, a jump bypass was created to the left renal vein. The swelling improved and the ulcers healed completely. Twenty-eight months after the complex reconstructions, he remains ulcer-free with mild edema controlled with stockings. Venous reconstructions remain a viable option for patients with symptomatic and recalcitrant nonmalignant obstruction of the large veins.
authors.affiliation: Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, 6550 Fannin Street, Houston, TX 77030, USA.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Adams
authors.forename: Jose E
authors.initials: JE
authors.lastname: Telich-Tarriba
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Dresser
authors.forename: Nyla
authors.initials: N
authors.lastname: Ismail
authors.forename: Eric K
authors.initials: EK
authors.lastname: Peden
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003251:Constriction, Pathologic; D004487:Edema / Q000209:etiology / Q000601:surgery; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D010690:Phlebography; D054070:Postthrombotic Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000209:etiology / Q000601:surgery; D058017:Vascular Grafting / Q000379:methods*; D020246:Venous Thrombosis / Q000150:complications*; D014945:Wound Healing