Chronologically, therapy has evolved from the relatively simple to the more complex (such as variety of shunts and radical correction) procedures, and finally, the interventional approaches as the main modality. However, for patients with type II (long segment occlusion in the inferior vena cava), major procedures maintain an essential role, especially the mesocavoatrial shunt. For those with type III (the HV lesions), shunts remain the procedures of choice. This increased use of the interventional methods is a reflection of greater clinical awareness and more frequent detection of much less severe cases. In stark contrast is declining numbers of advanced cases, signalling a landmark breakthrough in the management of BCS.
Preoperative venography before operation is indispensible in confirming the diagnosis and operation strategies. Patients with severe primary deep venous reflux and symptoms up to C3 may need simultaneous repair of the deep venous valves.
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