Re-intervention for occluded iliac vein stents

Abstract

Iliac vein stenting has become more frequent with improved diagnostic capabilities of intra-vascular ultrasound (IVUS) for recognizing May-Thurner syndrome, chronic venous insufficiency (CVI) and thrombus. In this manuscript, we discuss the reasons for initial stenting, with long-term outcomes and some of the associated pitfalls. The best techniques for re-intervention when iliac stents become occluded will also be discussed.

Bilateral external iliac vein compression—An important consideration in implantation of leadless permanent pacemaker

“…Many cases of iliac vein compression have been treated successfully by stenting 4 . However, our experience in this case showed that prolonged dilatation of the compressed lesion was not effective in restoring the geometry of the vein to the round shape necessary for smooth passage of the leadless pacemaker device.…”

May-Thurner Syndrome: An Interesting Presentation of Recurrent, Unprovoked Deep Vein Thrombosis

“…According to one study, severe in-stent restenosis, defined as less than 50%, occurred in 5% of stented limbs at 72 months, with thrombophilia by itself not being a risk factor. They noted that the largest contributor to re-stenosis was actually the underlying extent of thrombotic disease [ 19 ]. It can be deduced that those with May-Thurner Syndrome plus underlying atherosclerosis may be at a higher risk of needing repeat intervention.…”

“…Surgical intervention has advanced from open techniques to more modern endovascular therapy with angioplasty and stenting, followed by anticoagulation. In eligible patients, catheter-directed thrombolysis or mechanical thrombectomy are excellent options to remove the thrombus burden, visualize the affected area, and stent the stenotic lesion [17][18][19]. Lifelong anticoagulation is often recommended after surgical intervention, though there is some debate.…”

Cases of Venous Stent Failure in Lower Extremities

“…Insufficiency coverage of the lesion is important factor contributing to venous stent failure (7,8). A study conducted by Raju et al focused on re-interventions for non-occlusive stent malfunction, spanning a 10-year period and involving 1,085 limbs that underwent femoral-iliac-caval stenting (9).…”