Iliocaval and Femoral Venous Occlusive Disease

Abstract The high prevalence and pathologic role of NIVLs in symptomatic chronic venous disease (CVD) patients must be balanced with the frequent prevalence of NIVLs in the asymptomatic general population. In Raju’s series, 75% of limbs with NIVLs and concurrent reflux experienced a good or excellent outcome with stent placement alone, even when the reflux component, severe in many, was uncorrected. IVUS has become the diagnostic imaging modality of choice; coaxial technique allows the operator to examine the target lesion as sound waves are emitted from the catheter tip transducer. Patients presenting with iliac vein occlusive disease secondary to thrombosis are much more difficult to deal with technically, and stent patency is inferior to that of NIVL cases. Recanalization techniques are required. It has been shown that in two-thirds of patients with postthrombotic disease it is necessary to implant stents down to the groin below the inguinal ligament to improve inflow into the reconstructed iliac veins.