Endovascular Treatment Options for Chronic Venous Obstructions

Chronic venous obstructions have been treated by means of bypass surgery, until, in recent decades, it was surpassed by endovascular treatment options. Although techniques may differ, some issues should be universal. It is recommended that patients are treated under general anaesthesia. Secondly, obstructive lesions should be fully stented. Finally, self-expandable stents should mainly be used. Recanalization and stenting proved safe and efficient with excellent mid- and long-term patency rates. However, failures due to re-occlusion do occur and are basically related to imperfect stent design and/or suboptimal inflow. Therefore, the main focus should be on the development of optimal stent configuration, that is, sufficient length, highest possible radial force and flexibility. Moreover, the significance of endophlebectomy with or without creation of an arteriovenous fistula should be established.