AVF Session: Complex Venous Disease, CTOs, and Malformations

Hydration, In-Stent Thrombosis, and Post-Thrombotic Drug Targets

A pilot study found that one liter of intravenous saline significantly reduced incidental iliac vein stenosis on MRI, suggesting hydration status inflates false-positive compression findings. Mechanical thrombectomy for in-stent thrombosis cut estimated one-year reintervention costs nearly in half versus balloon venoplasty, and an experimental drug reduced post-thrombotic vein wall thickening in mice.

Venous Chronic Total Occlusion Recanalization

An expert overview of recanalizing chronically occluded iliac veins emphasized that inflow quality, not technique, is the strongest predictor of stent patency, with the most severe lesions achieving only about 60% one-year patency even in experienced hands. Open reconstruction is rarely needed, reserved for healthy patients with persistent ulcers and adequate inflow.

Rare Complications and Vascular Malformations

A case series described surgical extraction of an inferior vena cava stent that had eroded into the duodenum in a cancer patient, needing multidisciplinary bowel and vessel reconstruction. Other talks covered diagnosing hepatic and limb venous malformations, historically mislabeled as hemangiomas, and distinguishing them from true arteriovenous malformations.