Mid-term results of endovascular treatment for symptomatic chronic nonmalignant iliocaval venous occlusive disease

Abstract

Endovascular treatment of benign iliocaval occlusive disease is a safe and efficient minimally invasive technique with good mid-term patency rates. Moreover, it improves cases with obstruction only, as well as cases with associated reflux and obstruction. Primary stenting should always be performed by using self-expanding stents deployed under general anesthesia to avoid lumbar pain. In case of failure, the endovascular procedure does not preclude further surgical reconstruction.

CIRSE Standards of Practice Guidelines on Iliocaval Stenting

“…The most common complications are early (\30 days) and late rethrombosis with 1.5-3 % for early and roughly 5 % for late events [49,58]. Extension of the stent into the IVC is associated with contralateral iliac vein occlusion in approximately 1 % of patients [49].…”

Venous Pressure Gradient: It’s Role in Diagnosis and Treatment of Steno-Obstructions of Deep Venous System

“…In symptomatic patients, recanalisation of thrombosis veins is incomplete and the collateral circulation is inadequate resulting in distal venous hypertension with lower extremity swelling, pain worsened after ambulation, venous ulcers and others clinical manifestations of post thrombotic syndrome. Although venous outflow obstructions of the lower extremity may involve the entire venous system, iliocaval venous steno-obstructions, more than peripheral obstructions, play an important role in determining the most severe symptoms of venous insufficiency [1][2][3][4][5][6].…”

“…Moreover in the last decade a few authors describe the much broaded disease profile that emerged with the use of IVUS for diagnosis, finding the incidence of no thrombotic iliac vein outflow obstructions to be very high in symptomatic CVI cases; it has been known that the etiology of venous steno-obstructions can be primary (nonthrombotic) or secondary (post-thrombotic) with equal prevalence estimated in patients with chronic venous disease [2][3][4][5][6][7]. It was already known that primary forms are related to compression of the left iliac common vein, anatomically near to the hypogastric artery bifurcation, with presence of webs or membranes resulting from traumatic injury caused by pulsations of the artery [7,8].…”

“…Endovascular treatment involving the use of iliac venous PTA and stenting has become gold standard treatment [1][2][3][4][5][6][7][8][9][10][11].…”

Trombolisis mecánica y fármaco-mecánica en el tratamiento de trombosis venosa profunda sin respuesta clínica con tratamiento médico convencional

“…La evidencia disponible aconseja que la angioplastia se acompañe de stent para prevenir reestenosis elástica inmediata o recoil, aliviar compresión externa y establecer adecuado flujo de salida 31 . La mayoría de nuestros pacientes requirieron tratamiento complementario, 2/3 con necesidad de stents 4,19 , en especial en casos de síndrome de May-Thurner para evitar el recoil por compresión externa 28 .…”