title: Endovascular management of nonmalignant iliocaval venous lesions.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA. bderubertis@mednet.ucla.edu
authors.forename: Brian G
authors.initials: BG
authors.lastname: DeRubertis
authors.forename: Ali
authors.initials: A
authors.lastname: Alktaifi
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Jimenez
authors.forename: David
authors.initials: D
authors.lastname: Rigberg
authors.forename: Hugh
authors.initials: H
authors.lastname: Gelabert
authors.forename: Peter F
authors.initials: PF
authors.lastname: Lawrence
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D003251:Constriction, Pathologic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000473:pathology / Q000601:surgery*; D008297:Male; D062108:May-Thurner Syndrome / Q000601:surgery; D008875:Middle Aged; D019990:Perioperative Care; D014652:Vascular Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
chemical_list: D000925:Anticoagulants