Search

Complications after iliofemoral and inferior vena cava stenting are rare, and most can be managed effectively without significant long-term consequences for the patient. Nevertheless, the procedure is not without risk, and clinicians considering starting a venous practice must be aware of the range of complications that can occur, which range from minor access site bleeds to fatal arrhythmia from stent migration to the heart. Most complications can be avoided with appropriate patient selection, stent sizing, and careful access and deployment techniques. [ABSTRACT FROM AUTHOR]

Ilio-femoral venous reconstruction has progressed from being only performed by a limited number of pioneers (often using equipment repurposed from other areas of interventional radiology) to a discrete subspecialty of endovascular practice with a dedicated range of tools and increasingly evolved techniques to secure optimal results. This review is intended to reflect the modern practice of ilio-femoral stenting in the acute and chronic settings, from initial patient assessment to completion of procedure and follow-up care. [ABSTRACT FROM AUTHOR]

Imaging plays an important role in the identification and assessment of clinically suspected venous pathology. The purpose of this article is to review the spectrum of image-based diagnostic tools used in the investigation of suspected deep vein disease, both obstructive (deep vein thrombosis and post-thrombotic vein changes) as well as insufficiency (e.g., compression syndromes and pelvic venous insufficiency). Additionally, specific imaging modalities are used for the treatment and during clinical follow-up. The use of duplex ultrasound, magnetic resonance venography, computed tomography venography and intravascular ultrasound as well as conventional venography will be discussed in this pictorial review. [ABSTRACT FROM AUTHOR]

Abstract Background We would like to present an unusual case of simultaneous stenosis of renal graft artery and vein diagnosed four months after transplantation. both treated by stent placement. Our aim is to point at the fact that renal graft venous stenosis is very rarely reported in the literature and – as it is not easy to diagnose by routine US - it could be overlooked. If early detected it can be treated by stent placement. Case presentation We present a case of 36-old-male with renal failure who received a kidney graft from deceased donor. The patient experienced delayed graft function. No rejection was found in the biopsy. Four months after transplantation the kidney function deteriorated to sCr 280 µmol/l. Graft artery stenosis together with graft vein stenosis was revealed. Both lesions were dilated with stent placement, the graft function returned to 230 µmol/l and became stable for 10 years. Ten years after stent placement graft function deteriorated to 300 µmol/l. An in stent restenosis of arterial stent was detected. It was successfully dilated by the balloon, the graft function returned to 230 µmol/l and stays stable for another 5 years. Conclusions An unusual simultaneous transplanted kidney artery and vein stenosis treated by stent placement is presented. The patient had stable graft function for 15 years after the procedure with one re-intervention on arterial stent.

Abstract Background A stent with characteristics of a hybrid design may have advantages in improving the patency of symptomatic iliofemoral vein obstruction. This study assessed the safety and effectiveness of the V-Mixtent Venous Stent in treating symptomatic iliofemoral outflow obstruction. Methods Eligible patients had a Clinical-Etiologic-Anatomic-Physiologic (CEAP) C classification of ≥ 3 or a Venous Clinical Severity Score (VCSS) pain score of ≥ 2. The primary safety endpoint was the rate of major adverse events within 30 days. The primary effectiveness endpoint was the 12-month primary patency rate. Secondary endpoints included changes in VCSS from baseline to 6 and 12 months, alterations in CEAP C classification, Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-14) scores at 12 months, and stent durability measures. Results Between December 2020 and November 2021, 171 patients were enrolled across 15 institutions. A total of 185 endovenous stents were placed, with 91.81% of subjects receiving one stent and 8.19% receiving 2 stents. Within 30 days, only two major adverse events occurred (1.17%; 95% confidence interval [CI], 0.14–4.16%), below the literature-defined performance goal of 11% (P

Background: Postimplantation syndrome (PIS) is a known inflammatory response following endovascular stent placement, yet comparative data between venous and arterial stenting remains limited. This study seeks to evaluate the incidence, characteristics, and clinical implications of PIS across these two distinct vascular territories. Methods: We retrospectively analyzed 191 patients who underwent either venous (n = 36) or arterial (n = 155) stent placement. Data collection encompassed demographic profiles, perioperative laboratory findings, and clinical outcomes. The primary endpoint was the incidence of PIS, defined as the presence of fever (≥38 °C), leukocytosis, and elevated C-reactive protein (CRP) within 30 days postprocedure. Secondary outcomes included length of hospital and ICU stay, incidence of endoleaks, reintervention rates, and 30-day mortality. Comparative statistical analyses were conducted to assess differences between the venous and arterial stent groups. Results: PIS was observed more frequently in arterial stent patients, as evidenced by significantly elevated postoperative white blood cell counts at 24 and 48 h (p = 0.046 and p = 0.014, respectively), along with borderline CRP increases (p = 0.052). Fever occurrence peaked at 72 and 96 h postprocedure, predominantly in the arterial cohort. Furthermore, patients with arterial stents had significantly longer hospital stays (5.59 ± 0.46 days vs. 3.42 ± 0.36 days; p = 0.0018) and a higher rate of 30-day endoleaks (7.1% vs. 0%; p = 0.005). Despite similar mortality and major adverse cardiac event (MACE) rates between groups, arterial stent patients exhibited a greater need for reintervention. While PIS was less common among venous stent recipients, its potential impact on postoperative recovery warrants careful monitoring. Conclusions: Arterial stenting is associated with a higher incidence of PIS and a more pronounced systemic inflammatory response, contributing to longer hospitalization and increased postoperative complications. Although venous stent patients experience PIS less frequently, its occurrence should not be overlooked, as it may influence overall recovery and clinical outcomes. Recognition and management of PIS in both venous and arterial stent patients are critical to improving patient care and optimizing procedural success. [ABSTRACT FROM AUTHOR]

Background: We would like to present an unusual case of simultaneous stenosis of renal graft artery and vein diagnosed four months after transplantation. both treated by stent placement. Our aim is to point at the fact that renal graft venous stenosis is very rarely reported in the literature and – as it is not easy to diagnose by routine US - it could be overlooked. If early detected it can be treated by stent placement. Case presentation: We present a case of 36-old-male with renal failure who received a kidney graft from deceased donor. The patient experienced delayed graft function. No rejection was found in the biopsy. Four months after transplantation the kidney function deteriorated to sCr 280 µmol/l. Graft artery stenosis together with graft vein stenosis was revealed. Both lesions were dilated with stent placement, the graft function returned to 230 µmol/l and became stable for 10 years. Ten years after stent placement graft function deteriorated to 300 µmol/l. An in stent restenosis of arterial stent was detected. It was successfully dilated by the balloon, the graft function returned to 230 µmol/l and stays stable for another 5 years. Conclusions: An unusual simultaneous transplanted kidney artery and vein stenosis treated by stent placement is presented. The patient had stable graft function for 15 years after the procedure with one re-intervention on arterial stent. [ABSTRACT FROM AUTHOR]

Background: A stent with characteristics of a hybrid design may have advantages in improving the patency of symptomatic iliofemoral vein obstruction. This study assessed the safety and effectiveness of the V-Mixtent Venous Stent in treating symptomatic iliofemoral outflow obstruction. Methods: Eligible patients had a Clinical-Etiologic-Anatomic-Physiologic (CEAP) C classification of ≥ 3 or a Venous Clinical Severity Score (VCSS) pain score of ≥ 2. The primary safety endpoint was the rate of major adverse events within 30 days. The primary effectiveness endpoint was the 12-month primary patency rate. Secondary endpoints included changes in VCSS from baseline to 6 and 12 months, alterations in CEAP C classification, Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-14) scores at 12 months, and stent durability measures. Results: Between December 2020 and November 2021, 171 patients were enrolled across 15 institutions. A total of 185 endovenous stents were placed, with 91.81% of subjects receiving one stent and 8.19% receiving 2 stents. Within 30 days, only two major adverse events occurred (1.17%; 95% confidence interval [CI], 0.14–4.16%), below the literature-defined performance goal of 11% (P <.001). The 12-month primary patency rate (91.36%; 95% CI, 85.93–95.19%; P <.001) exceeded the literature-defined performance goal. VCSS changes from baseline demonstrated clinical improvement at 6 months (− 4.30 ± 3.66) and 12 months (− 4.98 ± 3.67) (P <.001). Significant reduction in symptoms, as measured by CEAP C classification and CIVIQ-14, was observed from pre-procedure to 12 months (P <.001). Conclusions: The 12-month outcomes confirm the safety and effectiveness of the V-Mixtent Venous Stent in managing symptomatic iliofemoral venous outflow obstruction, including clinical symptom improvement compared to before treatment. [ABSTRACT FROM AUTHOR]

Introduction: Venous sinus stenting is a well established alternative to cerebrospinal fluid diversion for the treatment of idiopathic intracranial hypertension (IIH) with associated venous sinus stenosis. During this procedure, distal guide catheter placement within the venous sinuses may be desirable to facilitate stent delivery. We report our initial experience using the TracStar LDP™ (Imperative Care, Campbell, USA, 0.088-inch inner diameter) as the guide catheter for intracranial access during venous sinus stenting. Methods: A multi-institutional retrospective chart review of a prospectively maintained IRB-approved database was performed. Consecutive patients who underwent venous sinus stenting from 1/1/2020-9/6/2021 for IIH were included. Patient characteristics, procedural details, TracStar distal reach, outcomes, and complications were collected and analyzed. Results: Fifty-eight patients were included. The mean age was 33.8 years and 93.1% of patients were female. Visual changes prompted evaluation in 86.2% of patients. Stent placement was successful in all patients. The TracStar LDP catheter was advanced to the location of stent placement in 97.9% of cases in which it was attempted. The large 0.088-inch inner diameter lumen enabled compatibility with all desired stent sizes ranging from six to 10 millimeters. Gradient pressure across transverse sinus stenosis dropped from an average of 19.5 mmHg pre-procedure to 1.7 mmHg post-stent placement (p < 0.001). Clinical improvement was achieved in 87.9% (51/58) of patients. There were no catheter-related complications. Conclusion: The TracStar LDP is a safe and effective access platform for reaching treatment locations in patients who present with idiopathic intracranial hypertension and who are candidates for venous sinus stent placement. [ABSTRACT FROM AUTHOR]

Abstract Background Sigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable. Case presentation A retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43–63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients. Conclusions Superior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement.

In the past decade, technologies to treat venous pathologies have increased dramatically, to the benefit of an often underserved and overlooked population of patients with venous disease. However, given the rapid release of various technologies, including venous-dedicated stents and thrombectomy devices across varied venous pathologies, evidence-based guidelines have been slow to develop. When discussing appropriateness of care, one needs to consider optimal patient selection, technical approach, medical management, and surveillance protocols, to name a few. All of which, in the venous space, are currently widely varied in practice. The future of deep venous work is limitless, but multicenter, randomized controlled trials are needed to optimally treat patients with venous disease. [ABSTRACT FROM AUTHOR]

Background: Sigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable. Case presentation: A retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43–63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients. Conclusions: Superior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement. [ABSTRACT FROM AUTHOR]

Abstract Background Cancer patients with pelviabdominal masses can suffer from lower extremity symptoms due to venous compression. The effectiveness of venous stenting has been established in extrinsic venous compression in benign conditions like May-Thurner syndrome. In this retrospective study we evaluate the efficacy and safety of caval, iliocaval and iliofemoral venous stenting for cases of extrinsic venous compression caused by malignant masses in cancer patients. Methods IRB-approved retrospective review of patients who underwent iliofemoral venography with venoplasty and stenting between January 2018 and February 2022 was performed. Patients with extrinsic venous compression caused by malignant masses were included. Data on patient demographics, pre-procedure symptoms, procedural technique, stent characteristics, outcomes and follow-up were collected. Descriptive statistics were used to assess technical success, clinical success, primary stent patency and adverse events of the procedure. Results Thirty-seven patients (19 males, 18 females) who underwent 45 procedures were included. Deep venous thrombosis (DVT) was present in 21 (57%) patients. Twenty-nine patients (78%, 95% CI 62–90%) reported clinical improvement of the presenting symptoms. The median overall survival after the procedure was 4.7 months (95% CI 3.58–5.99). Eight (22%) patients were alive at last follow up with median follow up of 10.33 months (Range 2–25 months). Twenty-six patients had patent stents on their last follow up imaging (70%, 95% CI 61%-91%). Two patients had a small access site hematoma which resolved spontaneously. Two patients developed moderate, and 1 patient developed severe adverse events related to post procedure therapeutic anticoagulation. Conclusion Venous stenting is a safe procedure and should be considered as part of the palliative care for patients with debilitating lower extremity symptoms related to iliocaval and iliofemoral venous compression. Graphical Abstract

Background: Cancer patients with pelviabdominal masses can suffer from lower extremity symptoms due to venous compression. The effectiveness of venous stenting has been established in extrinsic venous compression in benign conditions like May-Thurner syndrome. In this retrospective study we evaluate the efficacy and safety of caval, iliocaval and iliofemoral venous stenting for cases of extrinsic venous compression caused by malignant masses in cancer patients. Methods: IRB-approved retrospective review of patients who underwent iliofemoral venography with venoplasty and stenting between January 2018 and February 2022 was performed. Patients with extrinsic venous compression caused by malignant masses were included. Data on patient demographics, pre-procedure symptoms, procedural technique, stent characteristics, outcomes and follow-up were collected. Descriptive statistics were used to assess technical success, clinical success, primary stent patency and adverse events of the procedure. Results: Thirty-seven patients (19 males, 18 females) who underwent 45 procedures were included. Deep venous thrombosis (DVT) was present in 21 (57%) patients. Twenty-nine patients (78%, 95% CI 62–90%) reported clinical improvement of the presenting symptoms. The median overall survival after the procedure was 4.7 months (95% CI 3.58–5.99). Eight (22%) patients were alive at last follow up with median follow up of 10.33 months (Range 2–25 months). Twenty-six patients had patent stents on their last follow up imaging (70%, 95% CI 61%-91%). Two patients had a small access site hematoma which resolved spontaneously. Two patients developed moderate, and 1 patient developed severe adverse events related to post procedure therapeutic anticoagulation. Conclusion: Venous stenting is a safe procedure and should be considered as part of the palliative care for patients with debilitating lower extremity symptoms related to iliocaval and iliofemoral venous compression. [ABSTRACT FROM AUTHOR]

Background: The pathophysiology of Idiopathic Intracranial Hypertension (IIH) is poorly understood, making the disease difficult to properly diagnose and treat. Endovascular venous stenting has emerged as an effective non-invasive treatment option for a select cohort of IIH patients with venous sinus stenosis and elevated venous sinus pressure gradient. Unfortunately, current methods of determining patient eligibility for stenting treatment depend on highly invasive and insufficient measurement methods such as venous manometry, which can only measure pressure gradients and not other components of the complex 3D hemodynamic environment. Thus, there is a need for a non-invasive methodology for determining the 3D flow environment of the dural venous sinuses. Objective: To develop a novel method of non-invasive, patient-specific computational fluid dynamic (CFD) simulation of venous sinus hemodynamics for evaluating stenting eligibility. Method: A patient with IIH and elevated sinus pressure gradient underwent MR venography, phase-contrast MR venography, and venous manometry. Patient-specific dural venous anatomy was segmented from the MR venography to construct 3D models of the venous sinuses. 3D transient patient-specific computational fluid dynamic simulations were conducted using flow velocities measured with phase-contrast MR venography as boundary conditions. Results: Successful computational simulations were completed, allowing for the calculation of the spatio-temporal evolution of blood flow through the dural venous sinuses, and the quantitative examination of pressure gradients. Calculated pressure gradients from CFD were validated against venous manometry with an error of only ∼5%. Conclusions: We have successfully developed time-resolved, patient-specific 3D computational simulations of the dural venous sinuses without assumptions at the boundary conditions for the first time. The methodology can accurately and non-invasively measure venous pressure gradients. This preliminary study serves as a proof of concept for our method to be used as a diagnostic tool for determining venous stenting eligibility, as well as a tool for advancing the general understanding of IIH pathophysiology. Statement of Significance: The pathophysiology of Idiopathic Intracranial Hypertension (IIH) is poorly understood making the disease difficult to properly diagnose and treat. Endovascular venous stenting has emerged as an effective non-invasive treatment option for a select cohort of IIH patients with venous sinus stenosis and elevated venous sinus pressure gradient. Our work provides a method for noninvasively determining eligibility for venous sinus stenting, avoiding costly and invasive venous manometry.

Objective: Iatrogenic injury to the large abdominopelvic veins can he highly morbid, and open surgical repair is technically challenging. Endovascular repair with covered stenting across the injured segment offers an alternative to open surgical management. We present a series of patients with operative injury to the inferior vena cava (IVC) and iliac veins who were treated utilizing an endovascular approach and review the available literature on this technique. Methods: A PubMed keyword and MeSH term search was performed, and titles were reviewed for relevance by the first author. Studies related to endovascular repair of iatrogenic injury to the IVC and iliac veins were then read in detail for possible inclusion in the review. Those deemed appropriate were further analyzed for interventional approach, stent type and size, technical success, post-procedural pharmacologic management, complications and surveillance strategy. Results: The initial search resulted in 6221 publications. A total of 17 met criteria for inclusion, all of which were case reports or series. Twenty-six patients were described as suffering iatrogenic injury to the IVC or iliac veins, treated with various types and sizes of stents. All cases achieved technical success with hemorrhage control. Procedural complications occurred in 15.4% of cases, including 3 cases of acute thrombus formation and 1 case of stenosis caudal to the initial stent edge requiring additional stenting. Two additional patients experienced stent occlusion in the surveillance period. Conclusions: Endovascular repair of iatrogenic injury to the IVC and iliac veins can be an effective management option. However, due to limited data regarding this approach, many technical questions remain, including ideal size and type of stent graft, necessity and duration of post-procedural anticoagulant or antiplatelet therapy and appropriate surveillance. Additionally, long term outcomes in this population have not yet been described. [ABSTRACT FROM AUTHOR]

A 77-year-old man with history of sacral chordoma and pulmonary embolism presented to the emergency room with a 1-day history of diffuse left flank and lower extremity swelling. The patient was found to have thrombus in the left common and external iliac veins. The patient was brought to Interventional Radiology for mechanical thrombectomy using the Inari ClotTriever and a sample of extracted thrombus was sent to pathology. Analysis on the sample was positive for sacral chordoma, consistent with tumor thrombus. The patient returned after 6 weeks with similar symptoms and repeat mechanical thrombectomy was performed with the Inari ClotTriever and stent placement through the left common and external iliac vein with an Ovation iX stent graft. The patient remained asymptomatic following the second procedure at repeat follow-up at 6 weeks.

The post-thrombotic syndrome is a serious complication of deep vein thrombosis. Post-thrombotic iliac venous occlusion (PTIVO) is rarely associated with an arteriovenous fistula (AVF); however, the underlying mechanism remains unclear. We reported three PTIVO cases associated with an AVF, two symptomatic cases treated with venous stenting, and one asymptomatic case followed up conservatively. The essential imaging findings to diagnose PTIVO with an AVF were the presence of an arterial waveform on ultrasound examination and early opacification on contrast-enhanced computed tomography in the iliofemoral veins. Venous stenting resulted in the disappearance of the AVF, drastic improvement in symptoms, and an excellent long-term outcome.

Occlusion is a challenging complication of endovenous stenting. The treatment of chronic iliofemoral stent occlusion involves wire recanalization followed by balloon angioplasty. However, this approach will not always be successful. To treat such cases, we have successfully used a laser recanalization technique in 34 limbs (31 patients). This technique involved the use of a laser to first create a channel through the chronically occluded stent, followed by balloon angioplasty to improve the caliber of this recanalized tract. The mean age of the patients was 52 ± 13.6 years (range, 24-73 years). No adverse events related to the use of the laser occurred. Following laser recanalization, the venous clinical severity score had improved from 8.2 ± 4 to 5.1 ± 3.3 (P < .0001). The visual analog scale score for pain had improved from 7.8 ± 2.5 to 4.9 ± 3 (P = .0009). The grade of swelling had improved from 2.7 ± 1.3 to 1.6 ± 1.4 (P = .0001). At 12 months after intervention, the primary stent patency was 60% (standard error of the mean, 9.3%), and the secondary stent patency was 80%. Excimer laser recanalization of chronically occluded venous stents appears to be a rarely required but useful modality with reasonable clinical outcomes. Further reinterventions might be required to maintain long-term stent patency.

Symptomatic compression of the left common iliac vein between the right common iliac artery and spinal vertebrae is referred to as May-Thurner Syndrome (MTS). Atypical cases of MTS including compression of the left external iliac vein, right iliac vein or the inferior vena cava can also coexist and cause double vein compression. Current literature suggests that endovascular treatment including thrombolysis, thrombectomy, venoplasty and stent placement to correct the mechanical obstruction together with anticoagulation therapy is safe and a reasonable management for patients with MTS. Intravascular ultrasound (IVUS) can aid in the diagnosis and the operative planning of MTS, especially regarding sizing and precise deployment of venous stents. Here we present 2 unique atypical cases of MTS with double left iliac vein compression treated endovascularly with stent placement along the common and external iliac vein with the assistance of IVUS. [ABSTRACT FROM AUTHOR]

Background: Superior vena cava syndrome (SVCs) is a common complication in hemodialysis patients due to central vein occlusions, often caused by prior catheterizations. Management can be challenging., Objective: To describe a successful endovascular approach to managing SVCs caused by right innominate vein (RIV) occlusion in a hemodialysis patient with a non-functional LeVeen shunt., Method: An 80-year-old dialysis patient with upper limb edema and vascular access dysfunction was diagnosed with complete RIV occlusion around a long-standing LeVeen shunt. Recanalization was achieved via a percutaneous approach, including angioplasty and placement of a balloon-expandable covered stent, leaving the LeVeen shunt in situ to reduce risks., Results: The procedure restored venous patency and improved vascular access functionality. Postoperative imaging confirmed excellent stent positioning and reduced venous congestion. At a 6-month follow-up, central vein patency was maintained., Conclusion: Endovascular recanalization is a safe and effective strategy for managing SVCs, even with a retained central venous device. This approach preserved vascular access and ensured successful long-term dialysis, offering insights for treating complex venous occlusions., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A review of large studies where patients underwent stenting for symptomatic chronic iliofemoral venous obstruction (CIVO) and had validated clinical and/or quality of life metrics with a follow-up of at least 12 months was performed. Such studies were identified through searches of the MEDLINE and Embase databases in addition to a search of the Cochrane Central Register of Controlled Trials using appropriate search terms. These studies demonstrated that venous stenting is a durable intervention that confers clinical and quality of life improvement in patients with symptomatic CIVO who have failed conservative therapy. While significant improvement is common, complete resolution is rare, and in such patients, consideration should be given to treatment of other concomitant diagnoses including deep venous reflux, lymphedema, and chronic compartment syndrome.

Instent restenosis (ISR) represents the most common reason for recurrent symptoms requiring reintervention in patients who have undergone venous stenting for chronic iliofemoral venous obstruction. Treatment of ISR requires stent angioplasty typically using angioplasty balloons equal to or larger than the rated diameter of the stent. At times this does not yield the required result, and in these patients, utilization of a laser catheter supported by an angled sheath is helpful to ablate the ISR or make it more amenable to repeat balloon angioplasty. The authors report their experience with this technique for 18 patients with recurrent symptoms impacting quality of life as a result of recalcitrant ISR in this retrospective review of contemporaneously entered electronic medical record data. 12 (67%) limbs underwent laser ablation only, while 6 (33%) limbs underwent additional angioplasty post laser ablation. Post intervention for ISR, at 12 months, the venous clinical severity score improved from 5 to 3.5 (P = .0005) and the VAS pain score went from 7 to 5 (P = .0005). At 10 months, primary patency was 87% and primary assisted patency was 100%. There were no stent occlusions. Laser ablation of recalcitrant instent restenosis in patients presenting with recurrent chronic iliac venous obstruction post iliofemoral venous stenting is a safe and effective option. Corroboration from larger studies is warranted.

Chronic venous disorder (CVD) is highly prevalent vascular disorder affecting up to 45% of the general population, with clinical manifestations ranging from teleangiectasias to venous leg ulcers (VLUs). We examined the currently available data in order to provide an updated, comprehensive review on treatment options of CVD. We searched MEDLINE, Cochrane, Scopus, EMBASE, ClinicalTrials, and OpenGrey databases for relevant articles in English published until November 2020. Compression treatment is the mainstay of conservative treatment. Pharmacological treatment can provide significant symptomatic relief and hence it should be considered as part of conservative treatment. Transcutaneous Lacer treatment (TCL) is a safe and effective alternative option to sclerotherapy for treatment of C1 stage. High ligation and stripping (HL/S), ultrasound‐guided foam sclerotherapy (UGFS), endovenous thermal ablation (EVTA) systems and non thermal non tumescent ablation (NTNT) systems are safe and efficacious first‐line options for treatment of saphenous insufficiency. Interventional treatment of co‐existing incompetent perforator veins (IPVs) is not supported by contemporary evidence. Regarding deep venous insufficiency (DVI), treatment of symptomatic femoroiliocaval occlusive venous disease refractory to conservative treatment with percutaneous transluminal venoplasty stenting has produced encouraging results. [ABSTRACT FROM AUTHOR]

Objective: Report the usefulness of completion cone-beam computed tomography (CBCT) as an adjunct tool during femoro-ilio-caval recanalization post stent placement. Methods: Data from patients who underwent complex endovenous recanalization for chronic proximal outflow obstruction from January 2018 to May 2020 were analyzed. Two groups of patients were obtained based on the execution or not of completion CBCT. Outcomes, radiation, and contrast doses in the two groups were compared. Results: Fifteen patients (9 female, mean age 46.9 ± 13.3) in the control group and ten patients (7 female, 58.3 ± 14) in the CBCT group were included. In the CBCT group, one patient underwent an intraprocedural revision due to a residual lesion. The median total kerma area product (KAPtotal) and the total volume of contrast injected were not statistically different in the two groups. Conclusions: Completion CBCT after endovenous procedures might identify residual stenosis or stent malposition without a significant increase of total contrast injected and KAPtotal. [ABSTRACT FROM AUTHOR]

Postpartum venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a critical complication occurring in the postpartum period. The pathogenesis involves a hypercoagulable state induced by pregnancy-related physiological changes, venous stasis from reduced mobility and pelvic compression during delivery, and endothelial injury. Postpartum VTE is a leading cause of maternal morbidity and mortality, necessitating heightened clinical vigilance. Understanding the risk factors, implementing prophylactic measures, and ensuring timely intervention are paramount for improving maternal health outcomes related to venous embolic events.  The presented case is a 37-year-old female with a complex medical history marked by recurrent thrombotic events and pregnancy complications. Despite various prophylactic and therapeutic interventions, her condition culminated in severe chronic venous obstruction (CVO) requiring advanced interventional treatment and stent-graft implantation. Her medical history began in 2012 with two spontaneous abortions, leading to the identification of genetic mutations, including a homozygous methylenetetrahydrofolate reductase (MTHFR) mutation. In 2016, she developed PE after receiving hormonal contraceptive therapy without antithrombotic prophylaxis. Subsequent pregnancy was closely monitored, yet she suffered severe complications, including a cesarean delivery complicated by preeclampsia and postoperative thrombocytopenia, leading to massive iliofemoral-popliteal DVT. Initial treatment with vitamin K antagonists (VKA) was replaced with apixaban following a recurrent thrombotic event. Despite optimal anticoagulation, the patient developed symptomatic inferior vena cava (IVC) syndrome in 2022, characterized by chronic IVC occlusion, acute thrombosis of the portal and inferior mesenteric veins, and extensive collateral venous networks. She underwent recanalization and stenting of the iliac veins and IVC. This was followed by a hysterectomy due to metrorrhagia, significantly improving her quality of life. In this case, the homozygous MTHFR mutation was associated with recurrent thrombotic events and pregnancy complications. Despite multiple guidelines advising against MTHFR testing for thrombosis evaluation, the patient's management was influenced by her genetic profile and clinical history. Direct oral anticoagulants (DOACs) have shown efficacy in treating VTE in patients with hereditary thrombophilia. The clinical case also highlights the complexity of anticoagulation management, particularly after venous stenting, where maintaining stent patency poses significant challenges. Venous stenting, especially in CVO, has demonstrated substantial benefits, as evidenced by the patient's marked symptom improvement post-procedure. The long-term efficacy of stenting, optimal anticoagulation strategies, and post-procedural therapy require further research. This case highlights the complexities of managing hereditary thrombophilia with recurrent thrombosis and the evolving role of venous stenting in treating CVO. Individualized anticoagulation and multidisciplinary care are essential, with further studies needed to refine treatment and improve outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Stancheva et al.)

Chronic venous obstruction, including nonthrombotic iliac vein lesions and post-thrombotic syndrome, presents a significant burden on patients' quality of life and health care systems. Venous recanalization and stenting have emerged as promising minimally invasive approaches, yet challenges in patient selection, procedural techniques, and long-term outcomes persist. This review synthesizes current knowledge on the interventional treatment of post-thrombotic syndrome, focusing on the evolution of endovascular techniques and stenting. Patient selection criteria, procedural details, and the characteristics of dedicated venous stents are discussed. Particular emphasis is given to the role of inflow and other anatomical considerations, along with postoperative management protocols for an optimal long-term outcome., Competing Interests: Disclosures None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The overall goal of this report is to provide a high-level, practical approach to managing venous outflow obstruction (VOO)., Methods: A group of vascular surgeons from Australia and New Zealand with specific interest, training, and experience in the management of VOO were surveyed to assess current local practices. The results were analyzed and areas of disagreement identified. After this, the group performed a literature review of consensus guidelines published by leading international organizations focused on the management of chronic venous disease, namely, the Society for Vascular Surgery, American Venous Forum, European Society for Vascular Surgery, American Vein and Lymphatic Society, Cardiovascular and Interventional Radiology Society of Europe, and American Heart Association. These guidelines were compared against the consensus statements obtained through the surveys to determine how they relate to Australian and New Zealand practice. In addition, selected key studies, reviews, and meta-analyses on venous stenting were discussed and added to the document. A selection of statements with >75% agreement was voted on, and barriers to the guideline's applicability were identified. The final recommendations were further reviewed and endorsed by another group of venous experts., Results: The document addresses two key areas: patient selection and technical aspects of venous stenting. Regarding patient selection, patients with clinically relevant VOO, a Clinical-Etiologic-Anatomic-Physiologic score of ≥3 or a Venous Clinical Severity Score for pain of ≥2, or both, including venous claudication, with evidence of >50% stenosis should be considered for venous stenting (Level of Recommendation Ib). Patients with chronic pelvic pain, deep dyspareunia, postcoital pain affecting their quality of life, when other causes have been ruled out, should also be considered for venous stenting (Level of Recommendation Ic). Asymptomatic patients should not be offered venous stenting (Level of Recommendation IIIc). Patients undergoing thrombus removal for acute iliofemoral deep vein thrombosis, in whom a culprit stenotic lesion of >50% has been uncovered, should be considered for venous stenting (Level of Recommendation Ib)., Conclusions: Patients with VOO have been underdiagnosed and undertreated for decades; however, in recent years, interest from physicians and industry has grown substantially. International guidelines aimed at developing standards of care to avoid undertreating and overtreating patients are applicable to Australia and New Zealand practice and will serve as an educational platform for future developments., Competing Interests: Disclosures None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The minimally invasive procedures of venous ablation and iliac vein stenting are evolving treatment options for venous insufficiency. Yet, there are no studies directly comparing the outcome of these procedures. We performed a survey on patients who had both procedures, to determine if either procedure helped more and if there is any other clinical factor related to the outcome., Method: We collected data between Jan 2012 and Feb 2019 from 726 patients who failed to improve swelling after conservative management. The patients underwent iliac vein stenting and vein ablations. We recorded patient assessment of the leg immediately after completion of both procedures. Follow-up was performed using in-person questionnaires by asking if improvement in lower extremity swelling occurred and if so, which procedure helped more., Results: Of the 726 patients who underwent endovenous closure and iliac vein stent placement, 254 (35%) were males. The average age of the patients was 70 (±13.7 SD, range 29-103) years. The presenting symptom (C of CEAP classification) of lower extremity limb venous disease was 34.8%, 44.6%, 5.6%, and 15% for C3-C6, respectively. Patients were asked about swelling, and they stated: swelling is better (605, 83.3%), swelling is not better (118, 16.3%), and not sure if there is any improvement in swelling (3, 0.4%). Patients stated the following completion of both procedures: both procedures equally helped (129, 18%), iliac vein stent superior (167, 23%), endovenous ablation superior (177, 24%), neither helped (112, 16%), and not sure which procedure helped more (141, 19%). After ANOVA, we concluded that older patients (average = 72.5 years) were more often not sure which procedure helped more ( p = .024), and younger patients (average = 68.4 years) stated that endovenous ablation helped more ( p = .014). There were no significant differences between the groups regarding gender ( p = .9), laterality ( p = .33), or presenting symptoms scores ( p = .9). There was no statistical relationship between the procedure that was performed first and the procedure that helped more ( p = 0.095)., Conclusion: In this qualitative assessment, preliminary data suggest that the comparative role of iliac vein stent versus endovenous ablation warrants further study. The data were broadly distributed, and neither procedure was superior. In addition, 16% of the patients stated that neither procedure helped. The age of patients may also play a role in their procedure preferences and their subjective assessment for improvement., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To evaluate the performance of the Zilver® Vena™ Venous Stent in the treatment of patients with symptomatic iliofemoral outflow obstruction. Methods: Between August 2012 and January 2015, 35 patients (mean age of 45.1 ± 15.5 years; 77.1% female) with symptomatic iliofemoral venous outflow obstruction were treated with the Zilver Vena Venous Stent (Cook Ireland, Ltd.) as part of this prospective, single arm, multicenter study. Study assessments included procedural success, major adverse events (MAEs), freedom from occlusion and qualitative patency at 6 and 12 month post-procedure, clinical symptoms of venous insufficiency, and reintervention with the treated venous segment. Results: The rate of freedom from occlusion at 6 month and 12 month was 88.2%. The rate of qualitative patency was 88.2% at 6 month and 85.2% at 12 month. Three MAEs were reported: one symptomatic pulmonary embolism and two clinically-driven reinterventions. Following stenting, clinical symptoms of venous insufficiency improved significantly from baseline at each follow-up, as measured by VDS (p < 0.0001), CEAP "C" (p ≤ 0.0001), VCSS (p < 0.0001), and CIVIQ (p < 0.0001). Conclusion: Clinical results with the Zilver Vena Venous Stent were favorable through 12 month, with high patency rates, reduction of venous insufficiency symptoms, and low morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric vein of Galen malformations (VOGMs) are fistulous intracranial malformations arising congenitally within the choroidal fissure that can present with an array of neurological and cardiac sequelae. Associated venous stenosis may result in intracranial venous hypertension and ischemia leading to severe, irreversible cerebral injury. Management of neonatal VOGMs typically involves staged embolization and angioplasty/stenting for relief of venous stenosis. Rarely, jugular foraminal narrowing has been identified as causing jugular bulb stenosis. Case Presentation: We present the case of a 22-month-old female diagnosed with VOGM prenatally who displayed persistent intracranial venous hypertension despite multiple neuroembolization procedures during the neonatal period. Following initial reduction in arteriovenous shunting, she once again developed venous hypertension secondary to jugular bulb stenosis for which angioplasty was attempted. Failure of angioplasty to relieve the venous hypertension prompted skull base imaging, which revealed jugular foraminal ossification and stenosis. Microsurgical jugular foraminotomy followed by balloon angioplasty and stenting significantly reduced jugular pressure gradients. Restenosis requiring re-stenting developed postoperatively at 9 months, but the patient has remained stable with significant improvement in cortical venous congestion. Discussion/Conclusion: This case demonstrates the efficacy of microsurgical decompression of the jugular foramen and endovascular angioplasty/stenting as a novel treatment paradigm for the management of intracranial venous hypertension in the setting of VOGM. [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Background Migration of the left hepatic lobe into the potential space following right lobe resection can result in torsion and hepatic venous outflow obstruction with compromised venous return from the IVC. If untreated, significant morbidity and mortality can develop. Case presentation We report a case of a 29-year-old female with Lynch syndrome who underwent right lobe resection for a metastatic hepatic tumor. There was subsequent migration of the liver remnant, torsion of the IVC, and impaired hepatic outflow, successfully treated with thrombectomy and stenting. Conclusion Following right hepatectomy, hepatic venous outflow obstruction should be consdered in the setting of hepatorenal failure and hemodynamic instability. Endovascular stenting is a viable treatment option.

Objective: Current literature regarding iliofemoral intervention and stenting is mostly based on Western populations. We present our experience of iliofemoral stenting for chronic venous disease within a South‐East Asian population. Methods: This is a single‐centre retrospective review of a prospectively collected registry. Seventy‐one patients with 105 limbs underwent iliac vein IVUS and stenting between 2016 and 2019. All patients underwent pre‐procedure ultrasound venous scan and MRI venogram. Pre‐ and post‐operative CEAP classification, Villalta score and Venous Clinical Severity Score (VCSS), technical results, stent patency rates and complication rates are documented. Results: Seventy‐six per cent of the cases are non‐thrombotic iliac vein lesion, and 68% of patients have C4 to C6 disease. Ten percentage of patients had acute thrombosis on presentation. There was 100% technical success. A 6‐ and 7‐point reduction in the mean VCSS and Villalta score, respectively, were noted post‐stenting (baseline of 10 points and P < 0.001 in both categories). Post‐stenting ulcer healing rate was 91% at 6 and 12 months. One‐year ulcer recurrence and cellulites recurrence were at 8% and 7%, respectively. One unplanned 30‐day readmission (not related to procedure) and no 30‐day mortality were noted. Bleeding complication from anticoagulation was 3%. There was 10% in‐stent non‐flow limiting stenosis on surveillance. One‐year primary patency was 91%, and secondary patency was 100%. Conclusion: Within our series, iliofemoral stenting has 100% technical success, with statistically significant reduction in VCSS and Villalta score, good wound healing rates, low ulcer and cellulites recurrence and good primary and secondary patency rates at 1 year. [ABSTRACT FROM AUTHOR]

May-Thurner syndrome (MTS) is a rare condition that increases the risk of left-sided iliofemoral venous thrombosis due to compression of the left common iliac vein by the right common iliac artery. Treatment for symptomatic MTS typically includes combined anticoagulation and endovascular therapy. This patient presented to the emergency department with acute left lower extremity pain and swelling. After imaging confirmed MTS, the patient was discharged from the ED and expeditiously treated in an office-based lab (OBL) setting with venous thrombectomy, angioplasty, and stenting. The setting where endovascular therapy is performed may significantly impact access to care for patients. Additionally, cost-effectiveness is a factor that should be considered when deciding the treatment site of service. We demonstrate the safety and cost-viability of performing venous thrombectomy, angioplasty, and stenting in an outpatient setting for the treatment of acute iliofemoral venous thrombosis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nolan et al.)

Stenosis or obstruction of neck great veins represent a frequent and severe complication in hemodialysis patients. Endovascular treatment with percutaneous transluminal angioplasty and/or stenting of these veins is the gold standard to restore patency. However, the jugular vein is frequently overstented in these cases and this might lead to persistent symptomatology of those patients also losing an access for future catheter placement. Herein, we present the 6-months performance of a Y-shaped stenting of the brachiocephalic and internal jugular vein leading to complete resolution of the symptoms, and maintenance of the jugular vein access., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Deep-vein reflux has been a major cause for chronic venous insufficiency (CVI). Secondary reflux due to obstructive lesions has been treated with conservative methods. The advent of dedicated venous stent and intravascular ultrasound has renewed interest in the correction of obstructive component in CVI pathophysiology. We have followed a protocol-based approach for identifying the patients who would probably be benefitted with iliac vein stenting. Materials and Methods: Of the 156 patients who have presented to our institution over a 3-year period (2015–2018) with chronic venous insufficiency, based on the inclusion criteria, 31 patients were included with a probable diagnosis of deep-vein reflux due to obstructive iliac vein lesion. All these patients were subjected to duplex study initially and all had deep-vein reflux. Twenty-three patients had presented with superficial vein reflux. Magnetic resonance (MR) venogram was performed in all patients prior to proceeding with digital subtraction venography. Iliac vein stenting was performed in seven patients using wall stent. All patients had lesion on the left side with lesion ranging from 4 to 12 cm. Results: Seven patients who had iliac stenting had significant improvement in symptoms. Three patients had superficial venous ablative procedure done after 3 months combined with foam sclerotherapy. There were no procedure-related complications. Six-month follow-up study revealed one recurrent ulceration with bleeding superficial varices. Stent patency at 1-month follow-up was 100%. Symptomatic relief was achieved in all patients. Conclusion: Iliac vein stenting is effective in controlling CVI symptoms in selected patients. Those patients with potentially correctable lesions were identified with the application of duplex criteria for initial screening. Clinical examination and duplex criteria had equivalent predictive value compared to MR study. Symptom relief was achieved in all patients after iliac stenting. Those presenting with recurrence had adjunctive procedures with optimal results.

Central vein disease (CVD) is a well-known complication of central venous cannulations, indwelling dialysis catheters, and arteriovenous grafts. Brachiocephalic vein (BCV) stenosis or thrombotic occlusion can occur in dialysis patients, and the presence of an ipsilateral arteriovenous fistula can cause cerebral venous hypertension due to retrograde flow in the ipsilateral jugular vein. A 53-year-old man receiving hemodialysis (left brachiocephalic hemodialysis fistula) presented with impaired consciousness and seizures related to status epilepticus due to left temporal multifocal hemorrhages. Brain computed tomography and angiogram showed left cortical vein congestion without intracranial arteriovenous shunt. Complementary left brachial angiogram showed a left BCV stenosis and jugular and cerebral high-flow venous reflux with cortical venous reflux from the hemodialysis fistula. The left arm shunt resulted in severe cerebral venous hypertension due to ipsilateral stenosis of the BCV. BCV angioplasty immediately resolved the cerebral reflux. Patients with hemodialysis fistulas are at a higher risk of developing these intracerebral hemorrhage complications. [ABSTRACT FROM AUTHOR]

Aim: To assess the current evidence, controversies and technologies behind the various approaches and steps in the management of Paget-Schroetter syndrome. Materials and methods: We performed a narrative review based on a literature search in Embase, Medline, Pubmed and Google Scholar through keyword searching related to upper extremity deep vein thrombosis, Paget-Schroetter syndrome and venous thoracic outlet syndrome. Results: There is a paucity of high-quality evidence assessing the efficacy of contemporary approaches for the management of acute upper extremity deep vein thrombosis which, though promising, is largely limited to single institution case studies and small series. As a result, a formal systematic review could not be performed. Conclusions: Paget-Schroetter syndrome is a rare condition, whose management approaches are largely guided by the accumulated expertise and clinical experience of vascular specialists. In the absence of randomized controlled trials, current practice has been guided by retrospective reviews and experience. Modern approaches and protocols appear to remain distinct between health care facilities, but have common features including early clot lysis, surgical decompression with first rib resection, followed by adjunctive open or endovascular procedures. Further high-quality level 1 evidence and research are required in order to standardize treatment for this condition. [ABSTRACT FROM AUTHOR]

May-Thurner syndrome, also known as iliac vein compression syndrome, may cause symptoms of venous hypertension and is a predisposing factor for the development of iliofemoral deep vein thrombosis (DVT). Iliofemoral DVT is associated with high rates of development of postthrombotic syndrome, a potentially debilitating condition associated with development of symptoms related to venous outflow obstruction and resulting in reduced quality of life. In this Clinics article, we review procedural intervention with catheter-directed thrombolysis and stenting for iliofemoral DVT and iliac vein compression. [ABSTRACT FROM AUTHOR]

Purpose: The use of pharmacomechanical thrombectomy in patients with symptomatic iliofemoral deep venous thrombosis (DVT) not responsive to conservative treatment is under-investigated until now. This prompted us to review and analyze our results (technical/clinical outcome, complications) and compare them to the current literature.Materials and Methods: Between 2013 and 2019, 19 patients (14 women and 5 men; mean age: 41.2 years, SD: 18.2) with iliofemoral DVT and excessive pain not responsive to conservative treatment were treated with pharmacomechanical thrombectomy. Patients were followed up for 12 months. Demographics, technical success and clinical outcome data (pain score/Villalta score) were collected.Results: Thrombectomy ± thrombolysis was successful in all cases (n = 19). No major complications were observed. Eight out of nineteen cases developed hematoma at the sheath insertion site not requiring further treatment. Seven out of nineteen cases required additional continuous lysis for complete iliofemoral clot solution. All patients received balloon angioplasty to treat post-thrombotic strictures. In 16/19 cases, stents were placed to preserve iliofemoral caliber and maintain unrestricted iliac venous outflow. Three patients (16%) required re-intervention due to re-thrombosis or in-stent stenosis after 4, 14 days and 4 months, respectively. Symptoms could be improved temporarily or indefinitely in 19 out of 19 patients. 1 year following thrombectomy mean pain score was reduced by 87%, mean Villalta score was 2.6 (SD: 4), and iliofemoral veins were patent in 15/17 patients.Conclusion: In symptomatic patients with iliofemoral DVT, refractory to conservative treatment, catheter-directed thrombectomy enables rapid and long-lasting pain relief. High patency rates can be achieved in patients receiving PTA and venous stenting post-thrombectomy. [ABSTRACT FROM AUTHOR]

Competing Interests: None.

In recent years, deep venous stenting has increasingly become a treatment strategy for post-thrombotic syndrome. Stent thrombosis can occur, resulting in symptom recurrence despite medical therapy, and there are few options available for durable stent patency restoration. We present a case of a 50-year-old male with prior iliocaval reconstruction that experienced recurrent left lower extremity swelling secondary to occlusion of left external iliac and common iliac vein stents during follow-up. Mechanical thrombectomy with the RevCore System and angioplasty was performed. One month later, the patient demonstrated widely patent bilateral iliac vein stents and complete symptomatic resolution. The RevCore System is a feasible alternative for treatment of chronic in-stent thrombosis., Competing Interests: None.