Endovascular treatment of ilio-caval obstructive disease

Ilio-caval obstructive disease is currently treated by surgical techniqueswhich can be very invasive. Endovascular procedures represent a newand less invasive way to treat such lesions but long term results must beevaluated.Material and methods:From November 1995 to August 2006, 95 consecutive patients wereadmitted in our department for treatment of non-malignant ilio-cavalobstructive disease by angioplasty and stenting. Indications were:- Group I (n= 70, 59 women, median age: 44 years): symptomatic andinvalidating chronic lesions including 20 thromboses. Median CEAP,VDS and VCSS scores were preoperatively respectively of 3, 2 and9.- Group II (n= 25, 17 women, median age: 36 years): acute (less than 7days old) femoro-iliac deep venous thrombosis treated by surgicalvenous thrombectomy, creation of an arterio-venous fistula and endovasculartreatment of underlying venous obstructive disease. Theetiology was May-Thurner syndrome in 70 cases, post-thromboticocclusive disease in 18 cases, retroperitoneal fibrosis in 5 cases andinferior vena cava hypoplasia in 2 cases. All procedures were performedin the operating room mostly under general anesthesia. Stentingwas performed using self-expanding metallic stents (Wallstent) of16 mm of diameter in most cases.Results:Technical success rate was 98% (2 recanalization failure). No perioperativedeath or pulmonary embolism occurred. Six complications occurred:2 perprocedural stent migrations and 4 postpoperative thromboses(1 was successfully treated by surgical venous thrombectomy).Median length of stay was 2 days in group I and 8 days in group II.Median follow-up was 44.7 months (4-130). Two late occlusions weretreated by a Palma procedure. Primary and secondary patency rates inintention to treat were respectively of 83,5 % and 93,5 % in group I andof 76 % and 84 % in group II at 60 and 120 months. Median VDS scorewas at the end of the follow-up of 0 in group I and of 1 in group II.Conclusion:Endovascular treatment of ilio-caval obstructive disease is safe andefficient. It gave good long term patency rates with a poorly invasiveprocedure compared to conventional surgical techniques. Moreover incase of failure it does not preclude surgical therapy.