three. Diffuse distal chronic venous changes were noted in 88% of treated limbs. The chronic, nonocclusive DVT involved femoral, popliteal, and tibial segments in 62% versus a single segment in 9%. However, distal segmental occlusions were noted in 52% of the limbs; the majority of such tandem occlusions were femoral. Distal femoral lesions were not stented. Mean follow-up was 24 months. He reported actuarial primary, assisted, and secondary patency rates of 49%, 62%, and 76%, respectively. Clinical improvement was gauged with the pain scale where a significant decrease from level 4 to level 0 (p < 0.0001) was reported. Sixty-six percent of limbs showed resolution of open ulcers or stasis dermatitis at one year. Reflux was documented in 87% of treated limbs and involved both superficial and deep systems in 65% of these individuals. Perhaps the differences in the long-term iliocaval stent patency rates among separate series reflect variable treatment of distal, tandem obstructions as well as selective use of anticoagulation.
In 2004, Robbins et al. reported on two cases to demonstrate the value of endovascular correction of chronic longsegment inferior vena cava obstruction.13 A young woman, with Factor V Leiden, and a three-year history of progressive right limb edema was diagnosed with caval obstruction following MRV. A series of WallstentsTM were overlapped to reconstruct the iliocaval segments without thrombolysis. The bidirectional or through-and-through access was used to facilitate balloon dilatation and stent deployment at the intrahepatic, infrarenal cava, and right iliofemoral levels. Large diameter stents, 18 mm, were used in the cava, 1614 mm in the iliac, and 12-10 mm in the femoral. Right lower extremity edema resolved remained absent at six months. The patient was managed with warfarin and clopi-dogrel (Plavix) for six weeks and 81 mg daily aspirin long-term. The second case involved bilateral lower extremity edema and caval occlusion in a 72-year-old man with a three-year history of edema and venous claudication. The occluded IVC was approached through the patent right common femoral access. A sequence of Gianturco Z stents (Cook), dilated to 16 mm, was used to reconstruct the entire
IVC. The most proximal stent was placed in the intra-hepatic cava just below the right atrium. An additional left iliac lesion was treated with a single 14 mm Wallstent™. The extremity edema resolved rapidly, and he was managed with warfarin and aspirin. The patient was only followed for two months due to progression of his primary liver disease.
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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...