Endovascular recanalization of chronic long-segment occlusions of the inferior vena cava: midterm results.
OBJECTIVE
To report the midterm results of endovascular recanalization of chronic long-segment (> 5 cm) occlusions of the inferior vena cava (IVC) with stent placement.


METHODS
Nine patients (5 men; median age 30 years, range 14-58) with disabling complaints for more than 6 months caused by IVC occlusions were treated by endovascular recanalization. Mean occlusion length was 11 cm (range 6-22); some occlusions extended to the iliac (n = 3) or common femoral (n = 2) veins. All procedures were performed under local anesthesia via a bilateral femoral (n = 7) or popliteal (n = 2) approach. In 3 patients, combined access to the brachial or internal jugular vein was necessary. Patients with acute-on-chronic thrombosis were pretreated with urokinase. After guidewire recanalization, the chronic occlusions were predilated and self-expanding Wallstents were implanted.


RESULTS
The initial technical and clinical success was 100%. The venous clinical severity score (pain, venous edema, inflammation, and active ulceration) decreased from a mean 8 +/- 2 to 5 +/- 1 after the procedure. Over a median follow-up of 9 months (mean 21, range 4- 110), 3 patients died. One rethrombosis occurred, and an asymptomatic restenosis was discovered on routine imaging. The primary patency rate was 78%, and the 9-month occlusion-free survival rate was 56%.


CONCLUSIONS
Endovascular recanalization of chronic long-segment occlusions of the IVC is a safe and worthwhile technique to offer patients with debilitating symptoms.
te Riele
Wouter W
WW
Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Overtoom
Tim Th C
TT
van den Berg
Jos C
JC
van de Pavoordt
Eric D W M
ED
de Vries
Jean-Paul P M
JP
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery*