Endovascular Treatment for Deep Vein Thrombosis Complicated with Iliac Vein Compression Syndrome: Midterm Result

Abstract

Management of deep vein thrombosis (DVT) remains challenging. Anticoagulation therapy is effective in minimizing the incidence of recurrent thrombosis, and decreasing the risk of pulmonary embolism. However, in patients with severe and extensive DVT, anticoagulation treatment alone is not sufficient to relieve postthrombotic syndrome. We retrospectively evaluate mid-term outcome of endovascular treatment in two patients with DVT due to iliac vein compression syndrome (IVCS).

Case 1: 56-year-old woman was referred to our hospital because of swelling of left lower extremity. Computed tomography (CT) demonstrated intravenous thrombosis in the superficial femoral vein to the left common iliac vein. After IVC filter insertion, catheter-directed thrombolysis (CDT) was performed. Thereafter, 10×70 mm Easy Wallstent was deployed at the remaining stenotic site in the left common iliac vein probably because of compression by right iliac artery and spondylolisthesis. Anticoagulation therapy with warfarin was administered and it was continued. At the follow up of 54 months, no recurrent thrombosis nor stent obstruction are seen.

Case 2: 72-year-old woman presented in our hospital with swelling of left lower extremity. CT showed extensive venous thrombosis of the deep veins of the left leg extending into the left common iliac vein. Surgical thrombectomy was performed after IVC filter insertion. 12×100 mm Luminexx stent was inserted for the remaining iliac vein stenosis due to iliac compression. Anticoagulation therapy with warfarin was started. After 48 months, stent is patent and there is no sign of recurrent thrombosis.

Stent placement to alleviate stenotic lesion is safe and effective in the treatment of symptomatic lower extremity DVT caused by iliac compression.