Outcomes of the treatment of contralateral iliac venous thrombosis after stenting across the iliocaval confluence

Abstract

Among the complications related to the endovascular treatment of the left common iliac vein obstruction, the contralateral deep venous thrombosis consists in a late complication of the procedure. This case series describes the endovascular treatment of four patients with right iliofemoral deep venous thrombosis caused by jailing of the inferior vena cava confluence, due to previous stents implanted in the left common iliac vein. All the four patients were admitted with pain and swelling of the right lower limb, and one patient presented with phlegmasia cerúlea dolens. The patients were evaluated with duplex-scan and angioCT-Scan that confirmed extensive right iliofemoral and femoropopliteal deep venous thrombosis, except for one patient, whose DVT propagated to superficial femoral vein, without popliteal involvement. All patients were submitted to endovascular treatment with pharmacomechanical thrombectomy, previous stent recanalization and stent deployment in the iliocaval confluency. Regarding the post-operative complications, one patient presented with hemoglobinury, which evolved with anuria, and in the first day post-operative with acute kidney failure and necessity of hemodialysis for 8 days, after that evolved with total renal function recovery. During the hemodialysis period, this patient received non-fractioned heparin, instead of enoxaparin. All patients presented with satisfactory improvement on limb edema, in the first day and thereafter in the first week post-operative. The pharmacomechanical thrombectomy technique followed by angioplasty and kissing stenting was a safe and efficient procedure in this case series report.