Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis: early and late results.
OBJECTIVE
To evaluate, by imaging and clinical follow-up, the effectiveness and long-term results of stent placement in cases of common iliac vein obstruction associated with ipsilateral deep vein thrombosis (DVT).


METHODS
Retrospective analysis of 22 patients (13 women, nine men; median age, 58 years) with common iliac vein obstruction with ipsilateral DVT was performed for this study. All patients presented with leg edema or pain and were treated with catheter-directed thrombolysis (1,000-2,000 U urokinase per kg body weight per hour; n = 19), aspiration thrombectomy (n = 21), or angioplasty (n = 14) followed by stent placement (n = 22) via an ipsilateral popliteal vein approach (right, n = 2; left, n = 20) under ultrasonographic (US) guidance. Patients were then followed by duplex US, and patency rates were determined by Kaplan-Meier survival analysis.


RESULTS
The mean procedure time was 15 hours (range, 1-23 hours) and the mean urokinase dose was 1,980,000 U (range, 600,000-3,600,000 U) before the implantation of 27 stents. Three patients did not receive urokinase. The technical success rate was 96% (26 of 27 stents) and the clinical success rate was 95% (21 of 22 patients). The causes of common iliac vein obstruction were May-Thurner syndrome (n = 16), pelvic mass (n = 2), and unknown (n = 4). The early complications included upward stent migration in one patient and a spinal epidural hematoma in another. The late complication was partial stent obstruction, which was successfully treated by thrombolysis and angioplasty in one patient. Follow-up lasted 1-41 months (mean, 21.4 months). Overall, the 1-year and 2-year primary patency rates were both 95% and the 1-year and 2-year secondary patency rates were both 100%.


CONCLUSIONS
Directed catheter thrombolysis and aspiration of DVT are relatively safe, and the use of stents improves patency results in cases of common iliac vein obstruction.
Kwak
Hyo-Sung
HS
Department of Radiology, Chonbuk National University Medical School, 634-18 Keumam Dong, Chonju 560-182, South Korea.
Han
Young-Min
YM
Lee
Young-Sun
YS
Jin
Gong-Yong
GY
Chung
Gyung-Ho
GH
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000628:therapy*
D014568:Urokinase-Type Plasminogen Activator