Hyperemic maximal venous outflow unmasks symptomatic lower extremity venous obstruction

(Top) Air plethysmography demonstrates normal venous outflow in patient at rest. (Bottom) Using postocclusive reactive hyperemia techniques on the same patient reveals abnormal venous volumes, prompting further evaluation for obstruction.

Repeat ascending phlebography shows stenosis and a venous aneurysm in the area of previous operation. These findings were not considered significant on prior evaluation.

PTFE bands above and below the profunda femoris vein junction restrict outflow to the entire lower extremity.

A venous aneurysm and the first 2 cm of common femoral vein are resected and a ringed PTFE graft placed to repair the constricted segment. Descending phlebography demonstrates graft patency.

Postoperatively, noninvasive studies demonstrate normal venous outflow volumes at rest and with hyperemia.