Endovascular management of chronic iliac vein occlusion

Chronic venous insufficiency (CVI) affects millions of people in the United States. With CVI, higher venous pressure in the veins of the lower limb during exercise results in ambulatory venous hypertension and ulceration. The majority of cases of CVI occur after an episode of deep vein thrombosis (DVT). This results in damage to the valves in the deep venous system of the leg. Once damaged, the valves become scarred and incompetent, causing reflux of blood from the deep to the superficial venous system. Various theories are associated with the disease and ulceration process; the classic treatment of elevation, ambulation, and compression for venous disease remains unchallenged. A proportion of cases of CVI are caused by persistent venous obstruction, often superimposed upon valvular reflux. This article discusses techniques for endovascular reconstruction of iliac venous occlusions, which is an important cause of venous obstruction of the lower limb.