Endovascular treatment of post-thrombotic ileocaval-­femoral venous obstruction. A case report

According to widely published data, intravascular imaging (IVI)-guided endovascular venous stenting is an effective and safe alternative to open reconstructive surgery of the iliofemoral venous segment. Data on the potential of endovascular treatments for the ileocaval segment are currently insufficient. However, for some patients, this minimally invasive reconstructive surgery may be a viable alternative to open surgery. This article presents the case of a 48-year-old patient with severe postthrombotic disease, severe venous claudication, bilateral ileofemoral obstruction, and extensive occlusion of the infrarenal part of the inferior vena cava. Single-step endovascular IVI-guided recanalization and reconstruction of the ileocaval-femoral segment was performed with implantation of Abre™ and Wallstent™ venous stents. After 6 months, we revealed a decrease in venous hypertension symptoms, an increase in walking distance, a decrease in postthrombotic syndrome severity according to Villalta score, and an improvement in the Venous Clinical Severity Score.

1. Vedantham S, Weinberg I, Desai KR, et al. Society of Interventional Radiology Position Statement on the Management of Chronic Iliofemoral Venous Obstruction with Endovascular Placement of Metallic Stents. J Vasc Interv Radiol. 2023;34(10):1643-57.e6. doi:10.1016/j.jvir.2023.06.013.

2. Lobastov KV, Bondarchuk DV, Borsuk DA, et al. Diagnosis and treatment of chronic venous obstruction: consensus statement of the russian experts. Hirurg (Surgeon). 2020;(5-6):5-37. (In Russ.) doi:10.33920/med-15-2003-01.

3. Lichtenberg MK, Stahlhoff WF, Stahlhoff S, et al. Venovo venous stent for treatment of non-thrombotic or post-thrombotic iliac vein lesions — long-term efficacy and safety results from the Arnsberg venous registry. Vasa. 2021;50(1):52-8. doi:10.1024/0301-1526/a000893.

4. Hansch EC, Razavi MK, Semba CP, et al. Endovascular strategies for inferior vena cava obstruction. Tech Vasc Interv Radiol. 2000;3(1):40-4. doi:10.1053/tv.2000.5517.

5. Morris RI, Jackson N, Smith A, et al. A Systematic Review of the Safety and Efficacy of Inferior Vena Cava Stenting. Eur J Vasc Endovasc Surg. 2023;65(2):298-308. doi:10.1016/j.ejvs.2022.11.006.

6. Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-­based prevention, diagnosis, and treatment stra­tegies: a scientific statement from the American Heart As­so­ciation. Circulation. 2014;130(18):1636-61. doi:10.1161/CIR.0000000000000130.

7. Rabinovich A, Kahn SR. The postthrombotic syndrome: cur­rent evidence and future challenges. J Thromb Haemost. 2017; 15(2):230-41. doi:10.1111/jth.13569.

8. Gloviczki P. Open surgical treatment of post-thrombotic syndrome. In: Gloviczki P, ed. Handbook of Venous and Lymphatic Disorders. 4th ed. CRC Press; 2017:399-408. eBook ISBN: 9781315382449.

9. De Graaf R, de Wolf M, Sailer AM, et al. Iliocaval venous stenting: Long-term survey of postthrombotic symptoms and quality of life. J Vasc Surg Venous Lymphat Disord. 2021;9(1):156-63.e1. doi:10.1016/j.jvsv.2020.04.031.

10. Razavi MK, Marston W, Black S, et al. The Initial Report on 3-Year Outcomes of the VIRTUS Trial of the Venovo Venous Stent for the Treatment of Iliac and Femoral Vein Obstruction. J Vasc Interv Radiol. 2022;33(4):397-405.e2. doi:10.1016/j.jvir.2021.12.027.

11. De Graaf R, Arnoldussen C, de Wolf M, et al. Stenting for chronic obstructive venous disease: A comprehensive contemporary review. J Vasc Surg Venous Lymphat Disord. 2023;11(4):872-81. doi:10.1016/j.jvsv.2023.02.006.

12. Gargiulo NJ 3rd, Ahmed AM, Bertges DJ, et al. Society for Vascular Surgery clinical practice guidelines for iliac vein obstruction. J Vasc Surg Venous Lymphat Disord. 2023;11(2):255-66.e1. doi:10.1016/j.jvsv.2022.10.003.

13. Erben Y, Bjarnason H, Oladottir GL, et al. Endovascular re­canalization for nonmalignant obstruction of the inferior vena cava. J Vasc Surg Venous Lymphat Disord. 2018;6(5):551-8. doi:10.1016/j.jvsv.2018.03.010.

14. Black SA, Brodmann M, de Wolf M, et al. Clinical and technical considerations for femoral vein stenting. J Vasc Surg Venous Lymphat Disord. 2023;11(4):882-9. doi:10.1016/j.jvsv.2023.02.007.

15. Jayaraj A, Buck W, Knight A, et al. Impact of intravascular ultrasound on the outcomes of venous stenting for post-thrombotic and non-thrombotic iliac vein lesions. J Vasc Surg Venous Lymphat Disord. 2021;9(6):1441-9.e1. doi:10.1016/j.jvsv.2021.02.007.

16. Gohel MS, Epstein DM, Davies AH. Five-year outcomes of a pro­spective cohort of endovenous stenting for post-thrombotic ve­nous obstruction. Br J Surg. 2022;109(10):1014-7. doi:10.1093/bjs/znac111.

17. Neglén P, Darcey R, Olivier J, et al. Bilateral stenting at the ilioca­val confluence. J Vasc Surg. 2010;51(6):1457-66. doi:10.1016/j.jvs.2010.01.056.

18. de Graaf R, de Wolf M, Sailer AM, et al. Confluence Stenting for Chronic Venous Obstructions. Cardiovasc Intervent Radiol. 2015;38(5):1198-204. doi: 10.1007/s00270-015-1068-5.

19. Guo B, Chen C, Li Y, et al.; POATIVES collaborative study group. Principles of Optimal Antithrombotic Therapy for Iliac VEnous Stenting (POATIVES): A national expert-­based Delphi consensus study. J Vasc Surg Venous Lymphat Disord. 2024;12(2):101739. doi:10.1016/j.jvsv.2023.101739.

20. Schastlivtsev I, Lobastov K, Barinov V, et al. Diosmin 600 in adjunction to rivaroxaban reduces the risk of post-thrombotic syndrome after femoropopliteal deep vein thrombosis: results of the RIDILOTT DVT study. Int Angiol. 2020;39(5):361-71. doi:10.23736/S0392-9590.20.04356-4.