Endovascular management of nonmalignant iliocaval venous lesions

Iliocaval venous lesions produce a spectrum of symptoms ranging from mild swelling to venous ulcerations. In this study we examine the management and outcomes of these patients at our center.

In this study we performed a retrospective analysis of patients with symptomatic iliocaval venous stenoses, occlusions, or venous compression syndromes, who were treated with endovascular intervention during the period 2006-2010.

Of the 36 patients evaluated, mean age was 43.0 years; prior deep venous thrombosis (DVT), pulmonary embolism (PE), and hypercoaguable states were present in 55.5%, 25.0%, and 44.4%, respectively. Patients were stratified by the presence (group I, n = 22) or absence (group II, n = 14) of underlying May-Thurner (MT) syndrome. In group I, 11 patients had nonocclusive MT-related stenoses and 11 had acute DVT with underlying MT, causing pain/swelling (100%), venous claudication (66.7%), or CEAP class 3 (95%) or 6 (5%). Female preponderance was 2.1:1. Eighteen patients had successful intervention (angioplasty/stent with or without lysis), with clinical improvement in 94.4% and a decrease in CEAP score in 83.3%. All group II patients had chronic iliocaval occlusions causing: pain (100%); swelling (88.9%); venous claudication (44.4%); or CEAP class 3 (58%), 4 (25%), or 6 (8%). Recanalization was attempted in all patients and was successful in 71.4%. Successful recanalization was associated with clinical improvement in 88.9% and a decrease in CEAP score in 44.4%. Complications included 2 early reocclusions, 2 hematomas, and no cases of PE or death. Primary and secondary 1-year patency was 86% and 100% overall (mean follow-up 9.6 months). Primary 1-year patency for groups I and II was 87.5% and 83.3%, respectively.

Percutaneous intervention for chronic iliocaval venous lesions is associated with excellent 1-year patency rates and a significant reduction in symptoms and decrease in CEAP score.