Surgical femorocaval bypass for recalcitrant iliofemoral venous occlusion to endovascular treatment

Patients with chronic occlusion of iliac veins may present with symptoms ranging from mild discomfort to severe disability, including limb swelling, venous claudication, and ulceration. Endovascular treatment has emerged as first line of interventional therapy. Surgical venous-venous bypasses for the management of these patients in the era of endovascular therapy are rarely performed. These procedures are reserved only for patients with severe symptoms and long occlusive lesions that have failed previous endovascular interventions. We present a clinical scenario involving the use of femorocaval bypass to treat an iliofemoral occlusion recalcitrant to stenting, manifesting with severe lower extremity swelling and venous claudication. The surgical bypass resulted in significant improvement in the patient's clinical status.