Novel Treatment Techniques for Recanalization of Femoral-Popliteal Deep Venous Occlusion From Chronic Thrombosis

Diagnosis of stenosis within the popliteal–femoral venous segment upon clinical presentation with a venous ulcer and subsequent successful treatment with venoplasty

“…Even following treatment and subsequent recanalization, it may contribute towards lower limb clinical symptoms. 2,[6][7][8][9][10][11][12] It has been estimated that over 50% of individuals who have had a previous DVT develop post-thrombotic syndrome, 12 with ulceration developing in around 5%-10% of this cohort. 13 Following DVT, intraluminal fibrotic strands develop, thickening the vein wall, constricting the lumen, and limiting adequate venous drainage.…”

“…13 Following DVT, intraluminal fibrotic strands develop, thickening the vein wall, constricting the lumen, and limiting adequate venous drainage. 12,14 Partial recanalization and venous collateral formation are characteristics of a post-thrombotic limb, but provides inadequate blood diversion, as evidenced by the development of skin changes over time, manifesting as swelling, venous eczema, claudication, and venous ulceration. 12 Research has suggested that the speed of chronic venous disease progression, together with the severity of symptoms, is enhanced in post-thrombotic limbs.…”

“…12,14 Partial recanalization and venous collateral formation are characteristics of a post-thrombotic limb, but provides inadequate blood diversion, as evidenced by the development of skin changes over time, manifesting as swelling, venous eczema, claudication, and venous ulceration. 12 Research has suggested that the speed of chronic venous disease progression, together with the severity of symptoms, is enhanced in post-thrombotic limbs. 3,6 Enhanced risk of skin damage of a four-fold prevalence has been reported in post-thrombotic limbs relative to primary disease in one study, with other research highlighting the enhanced clinical severity coinciding with the combined impact of reflux and obstruction.…”

“…Post-thrombotic syndrome more commonly develops within and appears to elicit more severe symptoms with iliac vein and proximal femoral venous involvement. 12,14 The safety and efficacy of percutaneous iliac vein stenting has been reported for the correction of pelvic venous outflow obstruction; one study reported 88% stent patency at 5 years and an active ulcer healing rate of 54% within that same time. 7 Although it is significantly less common, there are reports of the development of stenosis within the popliteal-femoral venous segments, 12 but treatment of this condition with balloon venoplasty does not appear to be widely reported.…”

Management of Chronic Deep Vein Thrombosis in Women

“…Venography typically shows the main channel as a thin line (termed a "string" sign). 13,19 The vein is crossed using a 4-or 5-Fr catheter in combination with a hydrophilic wire. A braided catheter, such as the Cook CXI (Cook Medical), and a stiff Glidewire or Glidewire Advantage (Terumo Medical, Somerset, NJ) are used.…”