Endovascular surgery in the treatment of chronic primary and post-thrombotic iliac vein obstruction

Abstract

Objectives: To compare the results and complications of endovascular surgery in limbs with post-thrombotic and non-thrombotic disease and to detail some technical aspects of the procedure. Design: A single centre, prospective study. Materials and methods: Between March 1997 and August 1999, 139 consecutive lower extremities with chronic iliac venous obstruction (61 limbs with primary disease [MTS] and 78 with post-thrombotic disease [PTS]) were treated by balloon dilation and stenting. History, clinical examination, procedure and follow-up data were recorded. Results: Mortality was zero. Non-thrombotic complication rate was only 3%. Postoperative (8%, 6/78) and late occlusion (3%, 2/69) occurred only in post-thrombotic limbs. Primary, primary-assisted and secondary cumulative patency rates of the stented area at 2 years were 52%, 88% and 90%, respectively, in the PTS group as compared to 60%, 100% and 100% in the MTS group. Clinical improvement in pain and swelling was significant in both groups. Half of active venous ulcers healed after the procedure. Conclusions: Chronic iliac vein obstruction appears to be a symptomatic lesion that can be treated safely and effectively by endovascular surgery regardless of aetiology. Generous use of IVUS is suggested in both diagnosis and treatment since phlebography is unreliable. The clinical improvement was significant in both groups; however, more excessive neointimal hyperplasia and a higher early and late occlusion rate were observed in post-thrombotic disease. Stenting after balloon dilation is advised in all venoplasties; stents should be inserted well into the IVC when treating iliocaval junction stenosis. A wide-diameter (16 mm) stent is recommended. The stent should cover the entire lesion as outlined by the IVUS.