Endovascular iliocaval reconstruction for the treatment of iliocaval thrombosis: From imaging to intervention

Abstract

Thrombosis of the inferior vena cava and iliac veins, known as iliocaval thrombosis, is a common cause of significant morbidity. Patients with chronic iliocaval obstruction often present with life-limiting occlusive symptoms secondary to recurrent lower extremity deep venous thrombosis, swelling, pain, venous stasis ulcers, or phlegmasia. Endovascular iliocaval reconstruction is a technically successful procedure that results in favorable clinical outcomes and stent patency rates with few complications and is often able to relieve debilitating symptoms in affected patients. This review presents an approach to endovascular iliocaval stent reconstruction in patients suffering from chronic iliocaval thrombosis, including background, patient selection, timing of intervention, procedural steps, technical considerations, patient follow-up, and a brief review of outcomes. Schematic illustrations and clinical cases outlining iliocaval stent reconstruction and crossing chronic venous occlusions have been provided.

Stent Placement Across the Renal Vein Inflow in Patients Undergoing Venous Reconstruction Preserves Renal Function and Renal Vein Patency: Experience in 93 Patients

“…Iliocaval stent reconstruction has been previously described. 1,7,[12][13][14][15][16] Iliocaval reconstruction was performed via bilateral accesses to the great saphenous veins (or femoral veins) or single access to the common femoral vein and right internal jugular vein. A vertebral tip catheter (Terumo, Tokyo, Japan) and straight stiff guidewire (Terumo) were used for blunt recanalization.…”

“…If blunt techniques were unsuccessful, sharp recanalization using an 18-F BRK transseptal needle (Abbott Vascular, Redwood City, CA, USA) and loop snare was employed. [12][13][14][15][16] Balloon dilation of the IVC was performed to 18 mm, while the common iliac veins were dilated to 16 mm and the external iliac veins to 14 mm. Stent reconstruction of the IVC (Figure 1), including type and placement of stents, was guided by fluoroscopy, venography, and intravascular ultrasound at the discretion of the operator.…”

Hybrid CT-angiography to facilitate lower extremity sharp venous recanalization: a novel approach to a common procedure

“…Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) and a major cause of morbidity and healthcare costs (Williams and Dillavou 2020 ). For PTS secondary to chronic iliocaval thrombosis in which standard endovascular reconstruction techniques fail to cross the occlusion, sharp recanalization has been reported with high technical success (McDevitt et al 2019 ; Hage et al 2018 ; Ito et al 2012 ; Wadhwa et al 2018 ). However, severe or moderate adverse events are reported in up to 5% of cases, so novel imaging methods beyond traditional fluoroscopic projection (with or without cone-beam computed tomography (CT)) that allow safer needle guidance would be clinically relevant (McDevitt et al 2019 ; Ito et al 2012 ; Wadhwa et al 2018 ; Tanaka et al 2014 ).…”

Total endovenous recanalization and stent reconstruction for naïve non-inferior vena cava filter-associated chronic iliocaval occlusive disease: Placement of 352 venous stents in 69 debilitated patients

“…Thrombosis of the inferior vena cava (IVC) is a cause of significant patient morbidity, as it is a major contributing factor to deep venous thrombosis (DVT) and chronic venous insufficiency. 1,2 Patients with IVC stenosis or occlusion present with clinical symptoms of pain, varicoceles, and abdominal and pelvic collaterals as well as lower extremity varices, ulcers, and phlegmasia. 2,3 Endovascular stent reconstruction is the standard of care for the treatment of chronic iliocaval thrombosis, with favorable technical success rates, clinical outcomes, and stent patency rates, 3 though reported series have focused on IVC filter-associated thrombosis 4 and primary iliofemoral thrombosis without coexisting IVC thrombosis.…”

“…1,2 Patients with IVC stenosis or occlusion present with clinical symptoms of pain, varicoceles, and abdominal and pelvic collaterals as well as lower extremity varices, ulcers, and phlegmasia. 2,3 Endovascular stent reconstruction is the standard of care for the treatment of chronic iliocaval thrombosis, with favorable technical success rates, clinical outcomes, and stent patency rates, 3 though reported series have focused on IVC filter-associated thrombosis 4 and primary iliofemoral thrombosis without coexisting IVC thrombosis. [5][6][7] Several prior series have employed stent reconstruction for treatment of IVC thrombosis with good results.…”