LAUSR

BACKGROUND Chronic iliocaval obstruction is a challenging clinical entity to treat. Endovenous iliocaval stenting is becoming the treatment of choice for central vein stenosis and occlusion. However, outcomes in thrombotic disease have not been as robust as non-thrombotic disease. In this article we describe our experience utilizing covered stents as a novel tool for chronic total occlusions of the iliocaval veins. METHODS We performed a retrospective review of a prospectively maintained database of all patients undergoing endovenous stenting with a covered stent for chronic occlusive iliocaval disease over a 3 year period at our institution. Patients were followed clinically and with venous duplexes to assess the feasibility, safety, and outcomes of iliocaval endovenous stenting with covered stents. RESULTS A total of 10 patients (8 men and 2 women) underwent iliocaval stenting with covered stents from July 2015 - May 2018. A total of 20 self-expanding covered stents (SECS) and 13 balloon expandable covered stents (BECS) were deployed in the central veins of the 10 patients. Six SECS and 5 BECS were deployed in the IVC, 10 SECS and 6 BECS were deployed in the CIVs (5 patients had bilateral CIVs BECS and 2 patients had bilateral CIV SECS), and 4 SECS and 2 BECS were deployed in the EIVs (2 patients had bilateral SECS placed). Median follow up time was 12.1 (range, 0.5 - 35.0) months. There were no perioperative or postoperative complications. Nine (90%) patients maintained primary stent patency during our follow up time. One patient (10%) had re-thrombosis of his stent due to undertreated common femoral vein disease in the setting of a new myeloproliferative neoplasm and an inappropriate cessation of therapeutic anticoagulation. All patients who were symptomatic preoperatively had improvement in their pain, venous ulceration, and venous claudication. Eight of 9 (89%) patients had improvement of their lower extremity edema. CONCLUSION Covered endovenous stenting of chronically occluded central veins is a safe and promising procedure. Their use may improve the short and long term outcomes in this challenging patient population. Further studies are required to evaluate the long term efficacy and cost of their use.