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VENOUS DISEASE  GUIDELINES AND CONSENSUS Editor’s choice • Freefree

International Angiology 2020 February;39(1):3-16

DOI: 10.23736/S0392-9590.19.04278-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Management of acute and chronic iliofemoral venous outflow obstruction: a multidisciplinary team consensus

Stephen A. BLACK 1 , Abdulrahman ALVI 2, Sara J. BAKER 3, David BECKETT 3, Karen BREEN 1, Nicholas J. BURFITT 4, Simon COLES 5, Alun H. DAVIES 4, Neil DAVIES 6, Previn DIWAKAR 7, Anja DREBES 6, Kim FORTIN 8, Manjit GOHEL 9, Julian HAGUE 8, Christopher J. HAMMOND 10, Liz HASLAM 11, Robert G. JONES 12, Tanya KEARNEY 13, Eldon D. LEHMANN 14, James LENTON 10, Deborah LOW 15, James METCALFE 3, Hayley MOORE 14, Bhim J. ODEDRA 11, Shirish PRABHUDESAI 16, Shaun QUIGLEY 6, Lakshmi RATNAM 17, Toby RICHARDS 8, Prakash SAHA 1, Peter SCHNATTERBECK 14, James SCURR 7, Usman SHAIKH 7, Shoaib SHAIKH 18, Andrew SHAWYER 19, Richard TIPPETT 3, Sally VREBAC 8, Robert WARD 3, Christopher WATTS 3, Andrew WIGHAM 13, Andrew P. WILLIS 12, Nick WOODWARD 6, Chung S. LIM 6

1 Guy’s and St Thomas’ NHS Foundation Trust, London, UK; 2 Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK; 3 Dorset and Wiltshire Vascular Network, London, UK; 4 Imperial College London and Imperial Healthcare NHS Trust, London, UK; 5 Portsmouth Hospital NHS Foundation Trust, London, UK; 6 Royal Free London NHS Foundation Trust, London, UK; 7 The Royal Liverpool and Broadgreen University NHS Trust, London, UK; 8 University College London Hospitals NHS Foundation Trust, London, UK; 9 Cambridge University Hospitals NHS Foundation Trust, London, UK; 10 Leeds Teaching Hospital NHS Trust, London, UK; 11 Gloucestershire Hospitals NHS Foundation Trust, London, UK; 12 Queen Elizabeth Hospital Birmingham, London, UK; 13 Oxford University Hospitals NHS Trust, London, UK; 14 West London Vascular and Interventional Centre, London, UK; 15 Barts Health NHS Trust London, UK; 16 Ashford and St Peters NHS Foundation Trust, London, UK; 17 St. George’s Hospital University’s NHS Foundation Trust, London, UK; 18 Bradford Teaching Hospital NHS Foundation Trust, London, UK; 19 The Royal Bournemouth and Christchurch NHS Trust, London, UK



The aim of this manuscript was to establish a consensus for the management of acute and chronic venous obstruction among specialists in the UK. Specialist physicians representing vascular surgery, interventional radiology and hematology were invited to 3 meetings to discuss management of acute and chronic iliofemoral obstruction. The meetings outlined controversial areas, included a topic-by-topic review; and on completion reached a consensus when greater than 80% agreement was reached on each topic. Physicians from 19 UK hospitals agreed on treatment protocols and highlighted areas that need development. Potential standard treatment algorithms were created. It was decided to establish a national registry of venous patients led by representatives from the treating multidisciplinary teams. Technical improvements have facilitated invasive treatment of patients with acute and chronic venous obstruction; however, the evidence guiding treatment is weak. Treatment should be conducted in centers with multi-disciplinary input; robust, coordinated data collection; and regular outcome analysis to ensure safe and effective treatment and a basis for future evolvement.


KEY WORDS: Venous thrombosis; Mechanical thrombolysis; Stents; Post-thrombotic syndrome; May-Thurner syndrome

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