Chapter 60 - Treatment of iliac venous obstruction in chronic venous disease

Abstract

Venous balloon angioplasty and stenting is a safe, relatively simple, and efficient method to treat iliocaval vein obstruction. The introduction of endovascular treatment with percutaneous stenting drastically changed the treatment and view on venous outflow obstruction. Iliac venous stenting has largely replaced surgery as the “method of choice” for treatment of venous blockage. The relative simplicity, safety, and efficacy of the intervention has refocused the interest on the role of venous outflow obstruction in patients with chronic venous disorders, and has renewed interest in the nature and pathophysiology of venous obstruction in itself and in tests for detection of hemodynamically significant lesions. However, venous stenting is still under development, and there are several issues regarding diagnosis, assessment of outcome, and selection of patients, which needs to be resolved. Venous stenting must maintain the clinical improvement and high stent patency over a longer period. Longer-term results are now appearing and the initial favorable result appears to be maintained. The long-term effects of stents in the venous system are still not fully known. Several more years of monitoring is required to assess the efficacy and safety of this therapeutic modality in venous disease. In addition, further research on understanding the nature of venous obstruction and development of reliable methods to test hemodynamic consequences are needed.