Recanalization of totally occluded iliac and adjacent venous segments.

Abstract

The purpose of this study was to report our experience with percutaneous recanalization of totally occluded iliac veins and inferior vena cava. Recanalization of the iliac vein was performed in 38 limbs. In nine limbs, recanalization of the inferior vena cava was also necessary (two with filter). In 28 of 38 limbs, the stent was extended below the groin crease into the common femoral vein segment. Large-caliber (14 or 16 mm for iliac vein) flexible self-expanding stents were used. Stents were routinely extended for a short distance into the inferior vena cava to forestall development of iliocaval stenosis. Intravascular ultrasound scan was a valuable tool in the procedure. The median length of the recanalized segment was long (22 cm), and multiple stents (median, n = 3) were necessary in most patients. Forty-five percent of the patients had coagulation abnormalities. No morbidity or mortality was seen. Actuarial primary, primary assisted, and secondary patency rates of the stents at 24 months were 49%, 62%, and 76%, respectively. Median pain level decreased significantly (level 4 to level 0; P <.0001) after stent placement, and more than two thirds of the patients became totally pain free after the procedure. Swelling also improved significantly, and a third of the patients became totally free of any swelling after stent placement. Sixty-six percent of cases with stasis ulcers/dermatitis (n = 14) were resolved (actuarial, 1 year), although uncorrected reflux persisted in many of these limbs. Percutaneous recanalization of the occluded iliac vein with stent placement appears to be successful in the short term, with good patency, significant symptom resolution, and minimal morbidity.