title: Minimally invasive treatment of chronic iliofemoral venous occlusive disease.
abstract: BACKGROUND
  As one of the primary etiologies of the post-thrombotic syndrome, chronic venous occlusion is a huge burden on patient quality of life and medical costs. In this study, we evaluate the short-term and midterm results of endovenous recanalization by angioplasty and stenting in chronic iliofemoral deep venous occlusions.
  
  
  METHODS
  This is a retrospective observational study set in a tertiary medical referral center. Patients with venous claudication or C4-6 venous disease combined with duplex and magnetic resonance-confirmed iliofemoral or caval occlusion were included. Patients with recent deep vein thrombosis (<1 year) were excluded. The intervention was endovascular deep venous recanalization, followed by angioplasty and stenting. Safety and feasibility were clinically evaluated during the procedure and during follow-up. Reocclusions and other treatment failures were evaluated during a maximum follow-up of 31 months by ultrasound imaging and venography.
  
  
  RESULTS
  Seventy-five procedures were performed in 63 patients (average age, 44 years; range, 18-75 years), of whom 86% had a history of deep venous thrombosis. The mean time between the initial deep venous thrombosis and treatment with PTA and stenting was 12 years (maximum, 31 years). May-Thurner syndrome was present in 57%. Forty-two procedures were performed in the left, six in the right, and 11 in both lower extremities. The vena cava inferior was partially stented in 25 patients. An average of 2.6 stents (median, 2) were used per procedure. Primary patency was 74% after 1 year. Assisted primary and secondary patency rates were 81% and 96%, respectively, at 1 year. Secondary procedures included restenting, catheter-directed thrombolysis, endophlebectomy of the common femoral vein, and creation of an arteriovenous fistula. No clinically evident pulmonary emboli were noted. A bleeding complication occurred after six procedures and was deemed major in two. No patients died. Relief or significant improvement of symptoms of chronic venous occlusive disease was achieved in 81% of patients.
  
  
  CONCLUSIONS
  Endovenous recanalization by angioplasty and stenting of chronically occluded iliofemoral vein segments is a safe and effective treatment with good short-term results, even when treatment takes place decades after the initial deep venous thrombosis. Most reocclusions can be adequately treated by a secondary procedure.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: m.dewolf@maastrichtuniversity.nl.
authors.forename: Mark Antonius
authors.initials: MA
authors.lastname: Friedrich de Wolf
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Carsten Willem
authors.initials: CW
authors.lastname: Arnoldussen
authors.affiliation: Department of Vascular Surgery, Aachen University Hospital, Aachen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Grommes
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Shu Gi
authors.initials: SG
authors.lastname: Hsien
authors.affiliation: Department of Epidemiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Patricia Joan
authors.initials: PJ
authors.lastname: Nelemans
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Michiel Willem
authors.initials: MW
authors.lastname: de Haan
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Rick
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Vascular Surgery, Aachen University Hospital, Aachen, Germany.
authors.forename: Cees Hendrikus
authors.initials: CH
authors.lastname: Wittens