Deep Venous Reconstruction: A Case Series

Abstract

Objectives This study aims to review a case series of deep venous reconstruction procedures performed at one centre by a single consultant. Methods A retrospective review of deep venous reconstruction procedures performed by a single consultant from 1994 to 2013 was carried out and all notes were reviewed for outcomes. A 58-month cumulative patency rate was calculated using Kaplan-Meier survival analysis. Results Nineteen patients underwent deep venous reconstruction procedures including the Palma bypass, May-Husni bypass, femoral vein transposition and axillary vein transplant techniques from 1994 to 2013. Eleven patients were male and eight were female with a mean average age of 45.2 years (range 29-63). Clinical severity of disease ranged from C3 to C6, and 16 patients had a confirmed history of deep vein thrombosis. Cumulative primary patency rate for all reconstructions at 58 months was 89.5%, with two patients occluding and 17 remaining patent at last follow-up. Conclusion Deep venous reconstructions, particularly the Palma and May-Husni procedures, are feasible and can have good outcomes in patients failed by endovascular techniques and other more conservative therapies.

Keywords: chronic venous disease; chronic venous insufficiency; deep venous bypass; deep venous reconstruction; femoral-femoral crossover bypass; may-husni; palma; saphenopopliteal bypass.

Figure 1. The Palma (femoro-femoral bypass) and May-Husni (saphenopopliteal bypass) procedures.

Figure 2. Flow chart of case retrieval.

Figure 3. Kaplan-Meier survival plot for 58-month cumulative primary patency.

Figure 4. A comparison of results with the Mayo Clinic.

Figure 5. A flow chart demonstrating the current management of deep venous obstruction.