Venous Recanalization and Stenting After Iliac Vein Injury

Abstract

The objective of this study was to report an endovascular treatment for patients experiencing complications after iliac vein ligation. Management of venous injury consists largely of venous ligation or primary repair. Complications consist of lower extremity swelling, venous hypertension, venous thromboembolism, and compartment syndrome. Whereas conservative management is often successful for symptomatic swelling, there is little current literature regarding treatment of failed conservative therapy. A retrospective chart review performed from 2017 to 2020 identified three patients who underwent recanalization and venous stenting after previously ligated iliac vein. Case 1: A 23-year-old man suffered a gunshot wound to the left external iliac requiring ligation. He developed venous hypertension requiring fasciotomy of the left lower leg and thigh. Recanalization with stenting of the left external iliac vein with mechanical thrombectomy of the common femoral and external iliac vein was performed. Completion venography showed no residual stenosis. The patient was discharged on anticoagulation with normal flow on noninvasive studies 2 months later. Case 2: A 21-year-old man suffered a gunshot wound to the abdomen with injury to the inferior vena cava (IVC) and right iliac vein requiring ligation. Postoperatively, he developed iliac vein stenosis with symptomatic lower extremity swelling. Iliac vein recanalization with bilateral iliac vein stenting and IVC confluence reconstruction was performed. He was discharged on anticoagulation with patent venous stents and normal flow on noninvasive studies 2 months later. Case 3: A 44-year-old man presented with chronic swelling and left leg pain following ligation of the left iliac vein after iatrogenic injury during spinal surgery. Conservative compression therapy was unsuccessful. Preoperative computed tomography venography revealed chronic occlusion of the left iliac vein. Recanalization was performed, with improvement of flow through the left iliac system with filling into the IVC. The patient was discharged on anticoagulation, with patent stents on noninvasive studies at 6-month follow up. Venous recanalization with stenting is a successful treatment for complications after iliac vein ligation.