Abstract
The revascularization of the iliocaval segment is one of the most exciting and challenging
treatments of the vascular surgery. Particularly promising is the reconstruction in
case of renal cell carcinoma or adrenal neoplasma with tumor thrombus extension into
the inferior vena cava. In these cases an improvement of the quality of life and also
an increased life expectancy can be achieved. Experiences with replacement of the
inferior vena cava in tumor are very small and the follow-up, if reported, rarely
exceeds 1 year due to the underlying malignant disease. The reconstruction is indicated
only in a selected group of patients. In tumorous stenosis or obstruction of pelvic
veins, thrombectomy, venous dilatations with subsequent stent-implantation, carries
a minor operative risk and offers the opportunity to attain a better quality of life.
The Cross-Over-Bypass is indicated in cases of unilateral occlusion due to primary
or metastatic neoplasm with severely impaired peripheral microcirculation and impending
phlegmasia coerulea dolens. Autologous Cross-Pubic-Bypasses, by anteposition of the
external iliac vein on the affected side or by a graft from the contralateral healthy
superficial femoral vein, offer a useful alternative to the classical PALMA operation
or the PTFE Cross-Over-Bypass. The advantages of the autologous Cross-Public-Bypass
are a large graft diameter, low infection risk, and the transplantation of competent
venous valves.
