Endovascular Iliocaval Stent Reconstruction for Chronic Iliocaval Thrombosis

Purpose: Iliocaval thrombosis is associated with significant morbidity in the form of recurrent lower extremity deep vein thrombosis (DVT), life-threatening compromise from phlegmasia, development of postthrombotic syndrome (PTS), and death secondary to pulmonary embolism (PE). Iliocaval thrombosis has been reported in 3% to 30% of patients after inferior vena cava (IVC) filter placement and in 5% to 10% of patients with translumbar tunneled dialysis catheters. We aim to report the technical success, clinical outcomes, complications, and stent patency of iliocaval stent reconstruction for chronic iliocaval thrombosis in one patient with IVC filter–related chronic iliocaval thrombosis and another patient with translumbar tunneled dialysis catheter–related chronic iliocaval thrombosis.

Materials and Methods: Two patients with chronic iliocaval thrombosis with lower extremity swelling, pain, and healed venous stasis ulcers underwent iliocaval stent reconstruction for chronic iliocaval thrombosis. Technical aspects of stent reconstruction, technical success, and 1-month clinical follow-up were recorded and reviewed. Technical success was defined as recanalization, stent deployment, and restoration of inline venous flow. Clinical success was defined as decrease in CEAP score of at least 1 and resolution of presenting symptoms.

Results: Endovascular treatment consisted of percutaneous venous access, with or without IVC filter retrieval, recanalization of the occluded iliofemoral veins and IVC, with or without venous thrombectomy, transluminal venoplasty, and stenting of the IVC and iliac veins with self-expanding stents. Technical success with recanalization by blunt and sharp methods and restoration of inline venous flow and stent placement was achieved in both patients. Anticoagulation was initiated in both patients after the procedure. Clinical success with symptomatic improvement and decrease in CEAP score greater than 1 point was achieved in both patients after endovascular treatment. In both patients, there were no peri- or postprocedure minor or major complications related to endovascular iliocaval reconstruction.

Conclusions: Endovascular iliocaval stent reconstruction is an effective treatment for iliocaval thrombosis with symptomatic venous outflow disease and is associated with high technical success, low complication rates, favorable clinical outcomes, and favorable stent patency rates.