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Treatment of lower limb deep vein obstruction 

Treatment of lower limb deep vein obstruction
Chapter:
Treatment of lower limb deep vein obstruction
Author(s):

Peng Wong

and Gerard Stansby

DOI:
10.1093/med/9780199658220.003.0072
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date: 15 September 2019

The possibility of interventional treatment of deep venous obstruction is often overlooked due to challenges in diagnosis and patient selection. Recently, use of intravenous ultrasound has improved patient diagnosis. The results of balloon venoplasty and stenting have shown promising results, in terms of both clinical outcomes and patency rates. Endovenous intervention should be the first line of treatment if possible; however, its failure in patients with severe chronic venous insufficiency is an indication for open surgery. Unfortunately evidence for the efficacy of open surgery is confounded by small sample sizes and lack of randomized trials. Use of an arteriovenous fistula as an adjunct remains controversial. The patency of prosthetic grafts appears significantly lower than for autogenous vein grafts, which should be the preferred conduit. For infrainguinal obstruction saphenopopliteal bypass is rarely performed as results are poor. Patients with lower limb venous bypasses will require long-term anticoagulation to prevent graft thrombosis.

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