LAUSR

OBJECTIVE Prior literature has recommended routine iliac vein stent extension into the inferior vena cava (IVC) to assure adequate outflow for iliac vein stenting procedures. Our bias was that only the lesion should be stented without routine stent extension up to the IVC. We report our experience with this limited stenting technique. METHODS From 2012 to 2015, (844) patients (1216 limbs) underwent iliac vein stenting for non-thrombotic iliac vein lesions (NIVLs). All limbs were evaluated according to the presenting sign of the CEAP score, duplex scans and intravascular ultrasound (IVUS) showing more than 50% cross-section area or diameter reduction. All study patients had failed 3 months of conservative management. The procedures of iliac vein stenting were all office-based. Two techniques were compared: 1) placement of the iliac vein stent to cover the lesion and terminating cephalad into the IVC if the lesion involved the common iliac vein and 2) placement of the iliac vein stent to cover the lesion only and not passing the iliocaval confluence if the lesion only involved the external iliac vein. Complications were assessed during 30 days follow up using the duplex scan to look for thrombosis. RESULTS Of the total 844 patients, 543 (64%) were women. The average age was 66 (±14. 2) years (range, 21-99 years). The stent was placed in the left lower limb in 474 patients and bilateral in 370 patients. The presenting sign according to CEAP classification was (C3 = 626, C4 = 404, C5 = 44, C6 = 141). The average iliac vein stenosis by IVUS was 62% (± 12% SD). We had 715 patients with the iliac vein stent extending into the IVC and of these, 8 patients had thrombosis within 30days after the procedure. On the other hand, 501 patients had the iliac vein stent without crossing the iliocaval confluence and of these, 4 patients had thrombosis within 30 days of the procedure. There was no difference between these two groups in regards to gender (P=0. 1) or age (P=0. 3). Laterality was statistically different (P<0.0001) with more stents to be extended into the IVC if the lesion is in the left lower limb. Comparing these two groups in regard to 30-days thrombosis as a complication was not statically significant (P= 0. 6). There was no statistical difference between the two groups in regards to the presenting sign CEAP (P=0.6). CONCLUSION These results question the need for routine iliac vein stent extension into the IVC in patients with NIVLs. We were not able to demonstrate a significant risk of thrombosis with just placing the stent to cover the lesion only with short-term follow up.