Contralateral deep vein thrombosis after stenting across the iliocaval confluence in chronic venous disease – A systematic review

Abstract

Objective Stenting of the iliac veins is increasingly considered in the presence of symptomatic obstructive chronic lesions in the iliac vein segment. However, it is often necessary to extend the stented zone into the inferior vena cava, increasing the risk of contralateral iliac vein thrombosis. This study aims to review the current literature concerning the incidence of contralateral deep vein thrombosis after stenting across the iliocaval confluence. Methods A systematic review from potentially relevant published articles reporting contralateral deep vein thrombosis after iliac venous stenting between January 2007 and February 2019 was performed. Results A total of 764 references were retrieved initially. Twelve studies reporting events of contralateral deep vein thrombosis were selected for review, with a total of 1864 patients. Contralateral deep vein thrombosis incidence varied between 0% and 15.6%. The post-interventional and follow-up anticoagulation regimens were heterogeneous between studies. The decision to maintain patients on anticoagulation and the duration of treatment was based on the presence of comorbidities, hypercoagulable states, post-thrombotic syndrome and history of recurrent deep vein thrombosis. Patients with non-thrombotic iliac vein lesions were either anticoagulated for three or six months after stenting or received no anticoagulation. Patients with post-thrombotic syndrome were anticoagulated for longer periods. Most studies (eight studies) used an oral vitamin K antagonist agent. The data on compliance with anticoagulation treatment is scarce and few references present data on whether contralateral deep vein thrombosis occurred during anticoagulation treatment. The use of antiplatelet agents in addition to the anticoagulant treatment in the follow-up period was also variable. Conclusion The incidence of contralateral deep vein thrombosis due to iliac vein jailing is not negligible and reported being as high as 15.6%. Large-scale studies on the ideal antithrombotic treatment and its impact are necessary. It is possible that patients with stent crossing the iliocaval confluence might benefit from long-term antithrombotic treatment.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs

“…It usually results from stenting into the IVC, which is often unavoidable, thereby jailing the contralateral iliac vein. 391 5.3.6. Multidisciplinary team.…”

Thrombosis and Haemostasis 2023 Editors' Choice Papers

“…34 In the context of DVT, catheter-directed thrombolysis is commonly used with insufficient consensus on ideal patient selection and considerable variation in protocols and outcome assessments. Duarte-Gamas et al 35 conducted a systematic review and meta-analysis to address this variability, which underscored the need for standardized reporting in catheter-directed thrombolysis protocols and patient-centered outcomes. 36…”

Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis

“…[15][16][17] Information on the use of venous stenting and its complications in patients with acute or chronic DVT is largely based on observational studies, primarily consisting of case series and retrospective studies, as shown in recent systematic reviews. [18][19][20][21][22][23][24][25] In this context, a panel of experts from the Spanish Society of Internal Medicine, Spanish Society of Vascular and Interventional Radiology, and Spanish Society of Angiology and Vascular Surgery was assembled by the collaborating societies. We aimed to evaluate the available evidence and formulate specific recommendations regarding the indications, placement, follow-up, and prevention of complications associated with the use of venous stents for the management of DVTof the lower extremity.…”