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Abstract

Background

Iliocaval obstruction causes severe post-thrombotic syndrome (PTS) and impairs quality of life.

Purpose

To evaluate endovascular treatment efficacy for symptomatic iliocaval obstruction in PTS.

Material and Methods

A total of 17 patients underwent iliocaval venous reconstruction with stents between 2017 and 2022. All had bilateral iliac vein involvement; five presented with acute iliofemoral thrombosis and 12 with chronic iliocaval obstruction. All 17 patients had lower limb edema; nine patients reported lower limb pain (three acute iliofemoral thrombosis and six PTS) and four had active ulceration (all PTS). The technical results, adverse events, follow-up, and outcomes were documented.

Results

All patients received successful iliocaval reconstruction with stents in a kissing configuration, with successful outcomes. Over a mean follow-up of 46.5 ± 16.7 months (final follow-up in April 2025), all four patients with baseline venous ulcers achieved complete healing, and no new or recurrent ulcerations were observed. Significant clinical improvement was observed, with mean Villalta scores reducing from 17.6 ± 5.1 at baseline to 3.9 ± 1.6 at 1 month postoperatively (P <0.001). At final follow-up, only two patients had symptom recurrence (mean Villalta score = 6.1 ± 4.7), with no significant change from the 1 month (P = 0.5). Reintervention for stent stenosis occurred in 35.3%. Primary patency rates were 82.4% (12 months), 70.6% (24 months), and 64.2% (36 months); secondary patency rates reached 94.1% (12 months), 94.1% (24 months), and 82.4% (36 months).

Conclusion

Endovascular interventions for iliocaval obstruction are safety and effectiveness, with excellent patency rates achieved.

Keywords

Iliocaval obstruction recanalization stent reconstruction post-thrombotic syndrome endovascular treatment clinical outcomes

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References

Avgerinos

El-Shazly

Jeyabalan

, et al. Impact of inferior vena cava thrombus extension on thrombolysis for acute iliofemoral thrombosis. J Vasc Surg Venous Lymphat Disord 2016;4:385–391.

Agnelli

Verso

Ageno

, et al. The MASTER registry on venous thromboembolism: description of the study cohort. Thromb Res 2008;121:605–610.

Chaitidis

Kokkinidis

Papadopoulou

, et al. Management of post-thrombotic syndrome: a comprehensive review. Curr Pharm Des 2022;28:550–559.

Monreal

Agnelli

Chuang

, et al. Deep vein thrombosis in Europe-health-related quality of life and mortality. Clin Appl Thromb Hemost 2019;25:1076029619883946.

Pikovsky

Rabinovich

. Prevention and treatment of the post-thrombotic syndrome. Thromb Res 2018;164:116–124.

Chick

JFB

Srinivasa

Cooper

, et al. Endovascular iliocaval reconstruction for chronic iliocaval thrombosis: the data, where we are, and how it is done. Tech Vasc Interv Radiol 2018;21:92–104.

Erben

Bjarnason

Oladottir

, et al. Endovascular recanalization for nonmalignant obstruction of the inferior vena cava. J Vasc Surg Venous Lymphat Disord 2018;6:173–182.

de Graaf

de Wolf

Sailer

, et al. Iliocaval confluence stenting for chronic venous obstructions. Cardiovasc Intervent Radiol 2015;38:1198–1204.

Sebastian

Dopheide

Engelberger

, et al. Outcomes of endovascular reconstruction of the inferior vena cava with self-expanding nitinol stents. J Vasc Surg Venous Lymphat Disord 2018;6:312–320.

10.

Raju

. Treatment of iliac-caval outflow obstruction. Semin Vasc Surg 2015;28:47–53.

11.

Raju

Neglén

. Percutaneous recanalization oftotal occlusions of the iliac vein. J Vasc Surg 2009;50:360–368.

12.

Rodriguez

Tabrizi

Malgor

, et al. Sharp recanalization with the upstream GoBack catheter for chronic occlusive ilio-caval thrombosis. Ann Vasc Surg 2021;74:518.e7–518.e11.

13.

Williams

. Iliocaval reconstruction in chronic deep vein thrombosis. Tech Vasc Interv Radiol 2014;17:109–113.

14.

Comerota

Kamath

. Thrombolysis for iliofemoral deep venous thrombosis. Expert Rev Cardiovasc Ther 2013;11:1631–1638.

15.

Ding

, et al. Long-Term outcomes of endoluminal sharp recanalization of occluded inferior vena cava in Budd-Chiari syndrome. J Laparoendosc Adv Surg Tech A 2019;29:309–315.

16.

Caliste

Clark

Doyle

, et al. The incidence of contralateral iliac venous thrombosis after stenting across the iliocaval confluence in patients with acute or chronic venous outflow obstruction. J Vasc Surg Venous Lymphat Disord 2014;2:253–259.

17.

Banerjee

Patel

Sheorain

, et al. Double barrel in situ recanalization of thrombosed nonretrievable IVC filter. Ann Vasc Surg 2016;33:229.e11–229.e15.

18.

Neglen

Darcey

Olivier

, et al. Bilateral stenting at the iliocaval confluence. J Vasc Surg 2010;51:1457–1466.

19.

Chick

JFB

Gemmete

Hage

, et al. Stent placement across the renal vein inflow in patients undergoing venous reconstruction preserves renal function and renal vein patency: experience in 93 patients. J Endovasc Ther 2019;26:258–264.

20.

O'Sullivan

Lohan

Cronin

, et al. Stent implantation across the ostia of the renal veins does not necessarily cause renal impairment when treating inferior vena cava occlusion. J Vasc Interv Radiol 2007;18:905–908.

21.

Chick

JFB

Meadows

, et al. Endovascular iliocaval stent reconstruction for Inferior vena Cava filter-associated iliocaval thrombosis: approach, technical success, safety, and two-year outcomes in 120 patients. J Vasc Interv Radiol 2017;28:933–939.

22.

Neglén

Tackett

Jr. , et al. Venous stenting across the inguinal ligament. J Vasc Surg 2008;48:1255–1261.

Clinical outcomes of endovascular reconstruction for symptomatic iliocaval obstruction: a follow-up study

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

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References