title: Endovascular treatment of iliofemoral chronic post-thrombotic venous flow obstruction.
abstract: BACKGROUND
  Patients with deep vein thrombosis affecting the iliac and vena cava veins develop a more severe post-thrombotic syndrome than those with femoropopliteal disease. It has been traditionally treated only with medical therapy. During the last decade, endovascular repair has become the treatment of choice. The aim of this study is to report our midterm results using this technique.
  
  
  METHODS
  From 2009 to 2012, 41 limbs in 36 patients with post-thrombotic chronic flow obstruction of iliofemoral vein secondary to stenotic or occlusive lesions and with a clinical CEAP class 3 or higher or venous pain underwent percutaneous treatment. Stent-related outcome (patency and thrombotic events), clinical outcome (improvement of revised Venous Clinical Severity Score [VCSS] and Villalta score) were evaluated after intervention.
  
  
  RESULTS
  The procedure was successful in 39 limbs (95%) with no mortality and low morbidity. Thrombotic events occurred in nine limbs (23%) during the follow-up period. At 33 months, primary, assisted-primary, and secondary cumulative patency rates were 74%, 87%, and 89%, respectively. The main risk factor associated with stent occlusion was the severity of thrombotic disease. All postoperative thrombotic events occurred in occluded veins; no previously stenotic veins presented any complication (P = .04). Presence of thrombophilia, stent brand, and stent extension into the common femoral vein were not significantly associated with stent thrombosis. After surgery, the mean revised VCSS and Villalta scores improved substantially (P < .0001). The cumulative rate of revised VCSS improvement was 89% at 33 months. Clinical improvement was observed despite deep venous system reflux remaining uncorrected.
  
  
  CONCLUSIONS
  Percutaneous treatment of post-thrombotic venous flow obstruction is an excellent therapeutic option with low morbidity and no mortality. It can be performed with high midterm patency rates and midterm clinical improvement.
authors.affiliation: Angiology, Vascular and Endovascular Surgery Service, Instituto Vascular Internacional, Hospital Universitario Madrid Montepríncipe-Torrelodones, Universidad CEU-San Pablo School of Medicine, Madrid, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Blanch Alerany
authors.affiliation: Angiology, Vascular and Endovascular Surgery Service, Instituto Vascular Internacional, Hospital Universitario Madrid Montepríncipe-Torrelodones, Universidad CEU-San Pablo School of Medicine, Madrid, Spain. Electronic address: ivi@institutovascular.es.
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Izquierdo Lamoca
authors.affiliation: Angiology, Vascular and Endovascular Surgery Service, Instituto Vascular Internacional, Hospital Universitario Madrid Montepríncipe-Torrelodones, Universidad CEU-San Pablo School of Medicine, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Ramirez Ortega
authors.affiliation: Angiology, Vascular and Endovascular Surgery Service, Instituto Vascular Internacional, Hospital Universitario Madrid Montepríncipe-Torrelodones, Universidad CEU-San Pablo School of Medicine, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Lago Rivas
authors.affiliation: Angiology, Vascular and Endovascular Surgery Service, Instituto Vascular Internacional, Hospital Universitario Madrid Montepríncipe-Torrelodones, Universidad CEU-San Pablo School of Medicine, Madrid, Spain.
authors.forename: Romina
authors.initials: R
authors.lastname: Zotta Desboeufs
authors.affiliation: Angiology, Vascular and Endovascular Surgery Service, Instituto Vascular Internacional, Hospital Universitario Madrid Montepríncipe-Torrelodones, Universidad CEU-San Pablo School of Medicine, Madrid, Spain.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stefanov Kiuri