Balloon dilation and stenting of chronic iliac vein obstruction: Technicalaspects and early clinical outcome

Purpose: To describe the technical aspects of percutaneous balloon dilation and stenting for the treatment of venous outflow obstruction in chronic ve nous insufficiency. Methods: Between March 1997 and December 1998, 94 consecutive patients (med ian age 48 years, range 14 to 80) with suspected iliac vein obstruction in 102 limbs were studied prospectively with the intent to treat any venous oc clusion or stenosis verified during femoral vein cannulation. Data from the history, clinical examination, procedure, and follow-up were recorded. Pre operative indicators of obstruction were venographic evidence of occlusion, stenosis, or pelvic collateral vessels; increased arm-foot venous pressure differential; and abnormal hyperemia-induced venous pressure elevation. Results: Cannulation and technical success rates were 98% and 97%, respecti vely, with 118 Wallstents deployed in 77 veins. Primary, assisted primary, and secondary patency rates at 1 year were 82%, 91%, and 92%, respectively. Clinical improvement in pain and swelling was significant. Conclusions: Stenting of benign iliac vein obstruction is a safe method wit h good shortterm results. Venous lesions should always be stented; when tre ating iliocaval junction lesions, stents should be inserted well into the i nferior vena cava. Absence of collateral vessels does not exclude the exist ence of significant obstruction, and their presence may indicate an obstruc tion not visualized. No gold standard for accurate pre- or intraoperative p atient selection is currently available.