Percutaneous recanalization of total occlusions of the iliac vein

Venovenous bypass has been the standard in relieving chronic total occlusions of iliac veins. The technical feasibility of percutaneous recanalization was previously reported. Routine applicability of this technique in a wide spectrum of lesions and patients, stent patency, and clinical outcome forms the basis of this presentation.

During a 9-year period, 167 limbs in 159 unselected patients in a consecutive series with post-thrombotic chronic total occlusions of the iliac and adjacent vein segments underwent percutaneous attempts at recanalization. Patients were not selected based on venographic appearance or extent of the lesion, or excluded because of a preemptive choice of open venovenous bypass surgery.

Percutaneous recanalization was successful in 139 of 167 limbs (83%), including patients with bilateral occlusions and 14 patients with inferior vena cava filters incorporated in the treated occlusion. Median age was 53 years (range, 18-84 years). Thrombophilia was identified in 44 patients. Venous dermatitis/ulcer was found in 46% of the treated limbs. Recanalization involved three or more totally occluded vein segments in 42% of the limbs. The cumulative secondary stent patency rate at 4 years was 66%. The cumulative marked relief of pain and swelling at 3 years was 79% and 66%, respectively. Cumulative healing of venous ulcer at 33 months was 56%. Quality of life metrics improved significantly.

Most femoroiliocaval chronic total occlusions lesions can be successfully recanalized percutaneously with very little morbidity, minimal downtime, sustained long-term stent patency, and substantial clinical improvement. The procedure has wide applicability in a broad spectrum of symptomatic patients, including those with extensive lesions, and can be considered for routine use.