Iliocaval Reconstruction: Review of Technique, Challenges, and Outcomes

Abstract

Iliocaval thrombosis is a major source of morbidity for patients, with a range of clinical presentations, including recurrent lower extremity deep venous thrombosis and postthrombotic syndrome. Endovascular reconstruction of chronic iliocaval occlusion has been demonstrated to be a technically feasible procedure that provides long-lasting symptom relief in combination with antithrombotic therapy and close clinical monitoring. Herein, we describe the etiologies of iliocaval thrombosis, patient assessment, patient management prior to and after intervention, procedural techniques, and patient outcomes.

Keywords

iliocaval thrombosis - postthrombotic syndrome - iliocaval recanalization - venous reconstruction

Publikationsverlauf

Artikel online veröffentlicht:
20. Dezember 2022

• References

• 1 Khaja MS, Obi AT, Sharma AM. et al. Optimal medical therapy following deep venous interventions: proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2022; 33 (01) 78-85
• 2 Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris Jr JH. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics 2000; 20 (03) 639-652
• 3 Gil RJ, Pérez AM, Arias JB, Pascual FB, Romero ES. Agenesis of the inferior vena cava associated with lower extremities and pelvic venous thrombosis. J Vasc Surg 2006; 44 (05) 1114-1116
• 4 Lambert M, Marboeuf P, Midulla M. et al. Inferior vena cava agenesis and deep vein thrombosis: 10 patients and review of the literature. Vasc Med 2010; 15 (06) 451-459
• 5 Mabud TS, Sailer AM, Swee JKY. et al. Inferior vena cava atresia: characterisation of risk factors, treatment, and outcomes. Cardiovasc Intervent Radiol 2020; 43 (01) 37-45
• 6 Haskal ZJ, Potosky DR, Twaddell WS. Percutaneous endovascular creation of an inferior vena cava in a patient with caval agenesis, Budd-Chiari syndrome, and iliofemorocaval thrombosis. J Vasc Interv Radiol 2014; 25 (01) 63-69
• 7 Dougherty MJ, Calligaro KD, DeLaurentis DA. Congenitally absent inferior vena cava presenting in adulthood with venous stasis and ulceration: a surgically treated case. J Vasc Surg 1996; 23 (01) 141-146
• 8 PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005; 112 (03) 416-422
• 9 Angel LF, Tapson V, Galgon RE, Restrepo MI, Kaufman J. Systematic review of the use of retrievable inferior vena cava filters. J Vasc Interv Radiol 2011; 22 (11) 1522-1530.e3
• 10 Wik HS, Enden TR, Ghanima W, Engeseth M, Kahn SR, Sandset PM. Diagnostic scales for the post-thrombotic syndrome. Thromb Res 2018; 164: 110-115
• 11 Kaufman JA, Dimov IP, Kuehl K, Kanable A, Ballin J. Exercise intolerance in patients with chronic iliocaval venous occlusion: initial experience with noninvasive exercise testing before and after intervention. J Vasc Interv Radiol 2021; 32 (02) 305-308
• 12 Williams DM. Iliocaval reconstruction in chronic deep vein thrombosis. Tech Vasc Interv Radiol 2014; 17 (02) 109-113
• 13 Hage AN, Srinivasa RN, Abramowitz SD. et al. Endovascular iliocaval reconstruction for the treatment of iliocaval thrombosis: from imaging to intervention. Vasc Med 2018; 23 (03) 267-275
• 14 Quinlan DJ, Alikhan R, Gishen P, Sidhu PS. Variations in lower limb venous anatomy: implications for US diagnosis of deep vein thrombosis. Radiology 2003; 228 (02) 443-448
• 15 Hui JZ, Goldman RE, Mabud TS, Arendt VA, Kuo WT, Hofmann LV. Diagnostic performance of lower extremity Doppler ultrasound in detecting iliocaval obstruction. J Vasc Surg Venous Lymphat Disord 2020; 8 (05) 821-830
• 16 Khaja MS, Chick JFB, Schuman AD. et al. Fluoroscopic targeting of Wall stents and Amplatzer Vascular Plugs in sharp recanalization of chronic venous occlusions. Cardiovasc Intervent Radiol 2017; 40 (11) 1777-1783
• 17 Abou Ali AN, Avgerinos ED, Chaer RA. Role of venous stenting for iliofemoral and vena cava venous obstruction. Surg Clin North Am 2018; 98 (02) 361-371
• 18 Neglén P, Darcey R, Olivier J, Raju S. Bilateral stenting at the iliocaval confluence. J Vasc Surg 2010; 51 (06) 1457-1466
• 19 Barbati ME, Gombert A, Toonder IM. et al. Iliocaval skip stent reconstruction technique for chronic bilateral iliocaval venous occlusion. J Vasc Interv Radiol 2020; 31 (12) 2060-2065
• 20 Raju S, Hollis K, Neglen P. Obstructive lesions of the inferior vena cava: clinical features and endovenous treatment. J Vasc Surg 2006; 44 (04) 820-827
• 21 Arabi M, Krishnamurthy V, Cwikiel W. et al. Endovascular treatment of thrombosed inferior vena cava filters: techniques and short-term outcomes. Indian J Radiol Imaging 2015; 25 (03) 233-238
• 22 Desai KR, Xiao N, Karp J. et al. Single-session inferior vena cava filter removal, recanalization, and endovenous reconstruction for chronic iliocaval thrombosis. J Vasc Surg Venous Lymphat Disord 2019; 7 (02) 176-183
• 23 Vedantham S, Vesely TM, Parti N. et al. Endovascular recanalization of the thrombosed filter-bearing inferior vena cava. J Vasc Interv Radiol 2003; 14 (07) 893-903
• 24 Amin VB, Lookstein RA. Catheter-directed interventions for acute iliocaval deep vein thrombosis. Tech Vasc Interv Radiol 2014; 17 (02) 96-102
• 25 Partovi S, Kalva SP, Walker TG, Taj SM, Ganguli S. Long term follow-up of endo-vascular recanalization of chronic inferior vena cava occlusion secondary to inferior vena cava filters. Vasa 2017; 46 (02) 121-126
• 26 Chick JFB, Jo A, Meadows JM. et al. Endovascular iliocaval stent reconstruction for inferior vena cava filter-associated iliocaval thrombosis: approach, technical success, safety, and two-year outcomes in 120 patients. J Vasc Interv Radiol 2017; 28 (07) 933-939
• 27 Meltzer AJ, Connolly PH, Kabutey NK, Jones DW, Schneider DB. Endovascular recanalization of iliocaval and inferior vena cava filter chronic total occlusions. J Vasc Surg Venous Lymphat Disord 2015; 3 (01) 86-89
• 28 Elboraey M, Toskich BB, Lewis AR, Ritchie CA, Frey GT, Devcic Z. Iliocaval reconstruction of chronically thrombosed cylindrical inferior vena cava filters with balloon expandable covered stent-grafts. J Vasc Surg Cases Innov Tech 2021; 7 (03) 454-457
• 29 Majdalany BS, Monfore N, Khaja MS, Williams DM. Radiofrequency wire recanalization of chronically occluded venous stents: a retrospective, single-center experience in 15 patients. Cardiovasc Intervent Radiol 2019; 42 (01) 130-136
• 30 Hutten BA, Prins MH. Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism. Cochrane Database Syst Rev 2000; (03) CD001367
• 31 Fox BD, Kahn SR, Langleben D, Eisenberg MJ, Shimony A. Efficacy and safety of novel oral anticoagulants for treatment of acute venous thromboembolism: direct and adjusted indirect meta-analysis of randomised controlled trials. BMJ 2012; 345: e7498
• 32 Andras A, Sala Tenna A, Stewart M. Vitamin K antagonists versus low-molecular-weight heparin for the long term treatment of symptomatic venous thromboembolism. Cochrane Database Syst Rev 2017; 7: CD002001
• 33 Kishore S, Khaja MS, Thornburg B. et al. Antithrombotic therapy after venous interventions: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219 (02) 175-187
• 34 Lin C, Martin KA, Wang M, Stein BL, Desai KR. Long-term antithrombotic therapy after venous stent placement. Phlebology 2020; 35 (06) 402-408
• 35 Milinis K, Thapar A, Shalhoub J, Davies AH. Antithrombotic therapy following venous stenting: international Delphi consensus. Eur J Vasc Endovasc Surg 2018; 55 (04) 537-544
• 36 Endo M, Jahangiri Y, Horikawa M. et al. Antiplatelet therapy is associated with stent patency after iliocaval venous stenting. Cardiovasc Intervent Radiol 2018; 41 (11) 1691-1698
• 37 Raju S, Neglén P. Percutaneous recanalization of total occlusions of the iliac vein. J Vasc Surg 2009; 50 (02) 360-368
• 38 Murphy EH, Johns B, Varney E, Raju S. Endovascular management of chronic total occlusions of the inferior vena cava and iliac veins. J Vasc Surg Venous Lymphat Disord 2017; 5 (01) 47-59
• 39 Ye K, Lu X, Li W. et al. Outcomes of stent placement for chronic occlusion of a filter-bearing inferior vena cava in patients with severe post-thrombotic syndrome. Eur J Vasc Endovasc Surg 2016; 52 (06) 839-846
• 40 McDevitt JL, Srinivasa RN, Hage AN. et al. Total endovenous recanalization and stent reconstruction for naïve non-inferior vena cava filter-associated chronic iliocaval occlusive disease: placement of 352 venous stents in 69 debilitated patients. Vasc Med 2019; 24 (04) 349-358
• 41 Neglén P, Oglesbee M, Olivier J, Raju S. Stenting of chronically obstructed inferior vena cava filters. J Vasc Surg 2011; 54 (01) 153-161
• 42 Hartung O, Loundou AD, Barthelemy P, Arnoux D, Boufi M, Alimi YS. Endovascular management of chronic disabling ilio-caval obstructive lesions: long-term results. Eur J Vasc Endovasc Surg 2009; 38 (01) 118-124
• 43 Tosenovsky P, Vlaskovsky P. Quality of life after stenting for chronic iliocaval obstruction. Phlebology 2022; 37 (06) 469-475