title: Iliocaval Confluence Stenting for Chronic Venous Obstructions.
abstract: OBJECTIVE
  Different techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions.
  
  
  METHODS
  Between 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents.
  
  
  RESULTS
  Recanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7-1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency. In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29-337) days.
  
  
  CONCLUSIONS
  Stenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.
authors.affiliation: Department of Radiology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. r.de.graaf@mumc.nl.
authors.forename: Rick
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands. markthewolf@gmail.com.
authors.forename: Mark
authors.initials: M
authors.lastname: de Wolf
authors.affiliation: Department of Radiology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. anni.sailer@mumc.nl.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sailer
authors.affiliation: Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands. jorinde.van.laanen@mumc.nl.
authors.forename: Jorinde
authors.initials: J
authors.lastname: van Laanen
authors.affiliation: Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands. c.wittens@me.com.|Department of Surgery, University Hospital Aachen, Aachen, Germany. c.wittens@me.com.
authors.forename: Cees
authors.initials: C
authors.lastname: Wittens
authors.affiliation: Department of Surgery, University Hospital Aachen, Aachen, Germany. hjalaie@ukaachen.de.
authors.forename: Houman
authors.initials: H
authors.lastname: Jalaie
mesh_terms: D000293:Adolescent; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency; D014682:Vena Cava, Inferior / Q000601:surgery*; D055815:Young Adult
keywords: Deep venous thrombosis; Iliac vein; Inferior vena cava; Stent