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Proximal Chronic Total Venous Occlusion/Severe Stenosis With
Skin Changes at Risk for Venous Leg Ulcer (C4b), Healed (C5) or
Active (C6) Venous Leg Ulcer–Endovascular Repair
➤ In a patient with inferior vena cava or iliac vein chronic total occlusion
or severe stenosis, with or without lower extremity deep venous reflux
disease, that is associated with skin changes at risk for venous leg
ulcer (C4b), healed venous leg ulcer (C5), or active venous leg ulcer
(C6), we recommend venous angioplasty and stent recanalization
in addition to standard compression therapy to aid in venous ulcer
healing and to prevent recurrence. (1-C)
Proximal Chronic Venous Occlusion/Severe Stenosis (Bilateral)
With Recalcitrant Venous Ulcer–Open Repair
➤ In a patient with inferior vena cava or iliac vein chronic occlusion or
severe stenosis, with or without lower extremity deep venous reflux
disease, that is associated with a recalcitrant venous leg ulcer and
failed endovascular treatment, we suggest open surgical bypass with
use of an externally supported expanded polytetrafluoroethylene graft
in addition to standard compression therapy to aid in venous leg ulcer
healing and to prevent recurrence. (2-C)
Unilateral Iliofemoral Venous Occlusion/Severe Stenosis With
Recalcitrant Venous Ulcer–Open Repair
➤ In a patient with unilateral iliofemoral venous occlusion/severe
stenosis with recalcitrant venous leg ulcer for whom attempts at
endovascular reconstruction have failed, we suggest open surgical
bypass with use of saphenous vein as a cross-pubic bypass (Palma
procedure) to aid in venous ulcer healing and to prevent recurrence.
A synthetic graft is an alternative in the absence of autogenous tissue.
(2-C)
Proximal Chronic Total Venous Occlusion/Severe Stenosis
(Bilateral or Unilateral) With Recalcitrant Venous Ulcer–
Adjunctive Arteriovenous Fistula
➤ For those patients who would benefit from an open venous bypass, we
suggest the addition of an adjunctive arteriovenous fistula (4–6 mm
in size) as an adjunct to improve inflow into autologous or prosthetic
crossover bypasses when the inflow is judged to be poor to aid in
venous leg ulcer healing and to prevent recurrence. (2-C)
