A Systematic Review of Endovenous Stenting in Chronic Venous Disease Secondary to Iliac Vein Obstruction

Objective Stenting of the iliac veins is increasingly considered in the presence of symptomatic obstructive chronic lesions in the iliac vein segment. However, it is often necessary to extend the stented zone into the inferior vena cava, increasing the risk of contralateral iliac vein thrombosis. This study aims to review the current literature concerning the incidence of contralateral deep vein thrombosis after stenting across the iliocaval confluence. Methods A systematic review from potentially relevant published articles reporting contralateral deep vein thrombosis after iliac venous stenting between January 2007 and February 2019 was performed. Results A total of 764 references were retrieved initially. Twelve studies reporting events of contralateral deep vein thrombosis were selected for review, with a total of 1864 patients. Contralateral deep vein thrombosis incidence varied between 0% and 15.6%. The post-interventional and follow-up anticoagulation regimens were heterogeneous between studies. The decision to maintain patients on anticoagulation and the duration of treatment was based on the presence of comorbidities, hypercoagulable states, post-thrombotic syndrome and history of recurrent deep vein thrombosis. Patients with non-thrombotic iliac vein lesions were either anticoagulated for three or six months after stenting or received no anticoagulation. Patients with post-thrombotic syndrome were anticoagulated for longer periods. Most studies (eight studies) used an oral vitamin K antagonist agent. The data on compliance with anticoagulation treatment is scarce and few references present data on whether contralateral deep vein thrombosis occurred during anticoagulation treatment. The use of antiplatelet agents in addition to the anticoagulant treatment in the follow-up period was also variable. Conclusion The incidence of contralateral deep vein thrombosis due to iliac vein jailing is not negligible and reported being as high as 15.6%. Large-scale studies on the ideal antithrombotic treatment and its impact are necessary. It is possible that patients with stent crossing the iliocaval confluence might benefit from long-term antithrombotic treatment.

Download Full-text

Long-Term Outcomes of Stent Placement for Symptomatic Nonthrombotic Iliac Vein Compression Lesions in Chronic Venous Disease

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2012.01.068 ◽

2012 ◽

Vol 23 (4) ◽

pp. 502-503 ◽

Cited By ~ 11

Author(s):

Seshadri Raju

Keyword(s):

Stent Placement ◽

Iliac Vein ◽

Chronic Venous Disease ◽

Venous Disease ◽

Long Term Outcomes ◽

Iliac Vein Compression

Download Full-text

A Case of Successful Iliofemoral Vein Stenting from Great Saphenous Vein Access

The Heart Surgery Forum ◽

10.1532/hsf.2087 ◽

2018 ◽

Vol 21 (6) ◽

pp. E472-E475

Author(s):

Hae Won Jung ◽

Chul-Min Ahn ◽

Young-Guk Ko

Keyword(s):

Clinical Significance ◽

Treatment Option ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Good Alternative ◽

Iliac Vein ◽

Chronic Venous Disease ◽

Venous Disease ◽

Vein Access ◽

Successful Case

Chronic venous disease is strongly associated with morbidity and leads to considerable medical costs. Therefore, its clinical significance is very important. Currently, iliac vein stenting is the first treatment option for chronic venous disease due to iliac vein obstruction. For iliac vein stenting, ipsilateral femoral or popliteal vein access is common. However, great saphenous vein access may be a good alternative if there is obstruction in the ipsilateral femoropopliteal vein. Until now, there has been no reported case of successful iliac vein stenting using great saphenous vein access. We report the first successful case of iliofemoral vein stenting from great saphenous vein access.

Download Full-text

Computed tomography venography versus intravascular ultrasound in the diagnosis of iliofemoral vein stenosis

VASA ◽

10.1024/0301-1526/a000920 ◽

2021 ◽

Vol 50 (1) ◽

pp. 38-44

Author(s):

Ming Ren Toh ◽

Karthikeyan Damodharan ◽

Han Hui Mervin Nathan Lim ◽

Tjun Yip Tang

Keyword(s):

Computed Tomography ◽

Diagnostic Performance ◽

Iliac Vein ◽

Chronic Venous Disease ◽

Diagnostic Tools ◽

Venous Disease ◽

Significant Stenosis ◽

Vein Segment ◽

Vein Stenosis ◽

Computed Tomography Venography

Summary: Background: Iliofemoral vein stenosis can cause debilitating chronic venous disease. Diagnostic tools include both computed tomography venography (CTV) and intravascular ultrasonography (IVUS). We aim to compare the diagnostic performance of CTV and IVUS. Patients and methods: We performed a retrospective study of patients with chronic venous disease presenting with iliac vein compression or post-thrombotic limb symptoms, excluding those with acute deep vein thrombosis, high anaesthesia risk, or who had contrast allergy. All patients received CTV before IVUS, as part of the diagnostic work-up and intervention. The cross-sectional area (CSA) of iliofemoral vein segments obtained from both studies were compared against reference CSAs to derive percentage stenosis. A 50% reduction in CSA was considered significant. Results: We studied 50 patients between May 2018 and April 2019. 58% of patients had severe disease CEAP C5-6. 48% of patients had at least one vein segment with significant stenosis. The left proximal common iliac vein was the most commonly stenosed vein segment (n = 12, 24% on IVUS). CSA measurements from CTV were greater than those of IVUS, with a correlation coefficient of 0.57 (p < 0.005). Conversely, percentage stenosis measured on CTV was lower than on IVUS, with approximately one-third of significant stenosis missed on CTV (58 veins from CTV vs. 78 from IVUS, p < 0.005). With IVUS as the gold standard, CTV has low sensitivity (37.2%, 95% CI 26.5–48.9) and high specificity (92.5%, 95% CI 89.3–94.9) in detecting significant stenosis. Conclusions: CTV has limited diagnostic performance in identifying iliofemoral vein stenosis. Patients with normal CTV findings should proceed with IVUS imaging if the clinical features are supportive of iliofemoral vein stenosis.

Download Full-text