ABSTRACT
This chapter reviews the patient selection, diagnostic evaluation, techniques, and results of open venous reconstructions for chronic non-malignant occlusion of the iliac and femoral veins and of the inferior vena cava (IVC). Open surgical reconstructions of the IVC, the iliac vein, and the femoral vein are reserved for those symptomatic patients who are not candidates for endovascular reconstructions or who have failed attempts at venous stenting. Post-thrombotic femoral, iliac, or IVC obstructions have been the most frequent cause for open reconstruction of large veins in patients with non-malignant disease. Patients with membranous occlusion of the IVC frequently will have evidence of hepatic failure and portal hypertension as well. The iliac vein or the distal segment of the IVC is exposed retroperitoneally through an oblique flank incision. The IVC at the level of the renal veins is best exposed through a midline or a right subcostal incision.
