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Objectives: To show a simple endovascular technique both to do the diagnosis of the steno-obstructions of caval iliac femoral veins, in chronic venous hypertensions and to evaluate the results of angioplasty and stent treatment. Materials and methods: A total of 90 Patients (Pt) in CEAP clinical class 3-6 (according to CEAP classification-clinical, etiologic, anatomic, pathophysiologic for chronic venous disease) were evaluated for steno-obstructions of caval iliac femoral veins with a new technique of measurement of Venous Pressure Gradient (VPG) and with a morphological evaluation of these deep veins; we considered as indicator of venous hypertension a pressure gradient ≥3mmHg /400 Pa. In the first experience we analyzed 60 Pt; we considered eligible for the treatment of venous iliac Percutaneous Transluminal Angioplasty/Stenting (PTA/Stent). Only the patients with the presence of pressure gradient associated to a morphological stenosis >50%, measured through retrograde Digital Phleboscopy (DPh). We named Pt DPh this court of patients. In the second experience with the remaining 30 patients, we considered the patients with positivity to the pressure gradient are eligible for the treatment. In this case we used a new morphological technique Intra-Venous Ultrasound (IVUS), only to have a few details about neointima (Pt Iv). Technical success will be considered after the PTA /stent value of VPG is equal to 0mmHg/Pa. Clinical and Ultrasound (US) evaluation was performed before and after the treatment; in case of stenting we performed Computerized Tomography (CT) evaluation during follow up. Results: We have totally evaluated 90 Pt; in the first experience with 60 consecutive Pt ranked as CEAP III-VI. In 15 Pt we found VPG ≥ 3mmHg (≥ 400 Pa) and only 5 Pt with stenosis ≥ 50% by DPh. In these 5 Pt we performed iliac venous 4 PTA and 1 stenting. In the second experience with the remaining 30 consecutive Pt ranked as CEAP III-VI. In 6 Pt we found VPG ≥ 3mmHg (≥ 400 Pa). In all these Pt IVUS confirmed a morphological wall thickening without morphological stenosis to DPh. We performed iliac venous 4 PTA and 2 Stenting. We obtained the technical success after angioplasty/stenting of iliac vein steno-obstructions in all cases. No other complications is observed during the procedure. F.W. at 12 months (range: 3-24 months) showed a clinical down-staging in all patients with no occlusion in the site of the treatment. Conclusion: Our endovascular technique allows the measurement of the pressure gradient and the discover of the venous chronic hypertension in caval iliac femoral veins. The measurement of VPG provides the finding of iliac steno-obstructions without the evidence of stenosis by DPh. Moreover it is possible that the minimal changes in neointima can alter wall characteristics and its capacitance and increase the venous pressure. The VPG equal to 0mmHg/Pa after iliac venous PTA/stenting together with good clinical outcome could be used to show the effectiveness of the treatment of venous chronic hypertension.

Venous Pressure Gradient: It’s Role in Diagnosis and Treatment of Steno-Obstructions of Deep Venous System