Lower Extremity Chronic Venous Disease however, when the ankle-brachial index is <0.6 because it indicates an arterial anomaly needing revascularization [21]. Endovascular Stenting In a randomized trial by Rossi et al [49], iliac vein stenting was shown to improve symptomatology and QoL compared with medical treatment alone. Thus, based on the morbidity of moderate to severe post-thrombotic syndrome and the available clinical studies and experience with iliac vein stenting for post-thrombotic syndrome treatment, endovascular stenting is a useful treatment [15]. Saphenous Vein Ablation There is no relevant literature regarding the use of saphenous ablation in the treatment of iliocaval or lower extremity post-thrombotic changes. Compression Sclerotherapy There is no relevant literature regarding the use of foam and compression sclerotherapy or cyanoacrylates in the treatment of iliocaval or lower extremity chronic DVT. Venous Angioplasty When recanalization of femoral and popliteal veins is performed because of chronic post-thrombotic changes, angioplasty is typically the first-line therapy. Stenting of femoral vein below the lesser trochanter and popliteal veins is not routinely performed because of an increased risk of in-stent thrombosis and occlusion [80,81]. Venous Bypass Procedure Surgical iliac vein reconstruction and variations of venous bypass have been reported. Endovascular options, as discussed above, have proven to be a viable alternative. Venous bypasses in the setting of iliocaval and lower extremity venous disease can be performed in situations in which minimally invasive or conservative options are unsuccessful. The clinical success and patency of these bypasses are poor (infrainguinal) and associated with significant postoperative morbidity (suprainguinal surgery). Poor patency is likely due to low velocity through the graft, external compression, inherent thrombus formation, and/or inadequate distal venous inflow [82].
Lower Extremity Chronic Venous Disease. Lower Extremity Chronic Venous Disease however, when the ankle-brachial index is <0.6 because it indicates an arterial anomaly needing revascularization [21]. Endovascular Stenting In a randomized trial by Rossi et al [49], iliac vein stenting was shown to improve symptomatology and QoL compared with medical treatment alone. Thus, based on the morbidity of moderate to severe post-thrombotic syndrome and the available clinical studies and experience with iliac vein stenting for post-thrombotic syndrome treatment, endovascular stenting is a useful treatment [15]. Saphenous Vein Ablation There is no relevant literature regarding the use of saphenous ablation in the treatment of iliocaval or lower extremity post-thrombotic changes. Compression Sclerotherapy There is no relevant literature regarding the use of foam and compression sclerotherapy or cyanoacrylates in the treatment of iliocaval or lower extremity chronic DVT. Venous Angioplasty When recanalization of femoral and popliteal veins is performed because of chronic post-thrombotic changes, angioplasty is typically the first-line therapy. Stenting of femoral vein below the lesser trochanter and popliteal veins is not routinely performed because of an increased risk of in-stent thrombosis and occlusion [80,81]. Venous Bypass Procedure Surgical iliac vein reconstruction and variations of venous bypass have been reported. Endovascular options, as discussed above, have proven to be a viable alternative. Venous bypasses in the setting of iliocaval and lower extremity venous disease can be performed in situations in which minimally invasive or conservative options are unsuccessful. The clinical success and patency of these bypasses are poor (infrainguinal) and associated with significant postoperative morbidity (suprainguinal surgery). Poor patency is likely due to low velocity through the graft, external compression, inherent thrombus formation, and/or inadequate distal venous inflow [82].