Endovascular recanalization of chronic long-segment occlusions of the inferior vena cava: Midterm results

Purpose: 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 4110), 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%. Conclusion: Endovascular recanalization of chronic long-segment occlusions of the IVC is a safe and worthwhile technique to offer patients with debilitating symptoms.