Endovenous treatment of patients with iliac-caval venous obstruction.

Liberal use of intravascular ultrasound in symptomatic chronic venous disease (CVD) patients and the advent of venous stent technology have introduced a new paradigm of treatment for these conditions that often required open surgery in the past. Iliac outflow obstruction is present in >90% of limbs with CVD symptoms including in ''primary'' cases. In the latter, the obstructive lesion appears to function as a permissive lesion, provoking symptoms when additional secondary pathology is added. Like other known permissive lesions in human disease, symptom relief occurs after correction of the permissive lesion with a stent even when the secondary pathology is left uncorrected. Long-term stent patency is astonishingly high in ''primary'' disease and only slightly less in post-thrombotic subsets. Totally occluded veins, including those involving long segments of the ilio-femoral vein and vena cava, can be successfully recanalized with stent technology. The technique is minimally invasive and is carried out on an outpatient basis. Morbidity and mortality are minimal. Clinical results are excellent, including rather unexpected sustained healing of stasis ulceration in about 60% of patients. Later open surgery of the traditional types is not precluded should the stent were to fail. These attributes hold the promise of wider application of stent technology to a class of symptomatic CVD patients than was possible with open surgical techniques.