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Objective:
To evaluate the management and outcome of thrombosed iliac vein stents in patients with severe venous stasis in an office based setting.
Materials and Methods:
910 limbs in 709 patients underwent iliac vein stenting for severe venous stasis during a two and a half year period from July’12 until December ’14. Patients were deemed eligible for iliac vein stenting after they had failed conservative medical management. 173(19%) patients had normal veins while the remaider 737(81%) had iliac vein stenosis identified by intravascular ultrasound and treated with self expanding stents. 632 (78%) were unilateral and 105 (22%) were bilateral. The average age was 68.5 ±14.3 (Range 23 - 97 y), 69% female, an average CEAP of 3.56 ± 1.23, and 51% of identifiable stented venous lesion were left sided. Average follow up was 10 months ± 7.7 months.
Results
Technical success was achieved in 100% of patients, with 100% of cases done percutaneously. In our cohort 65% of patients reported less pain, 57% had ulcer healing, and 86% with decreased edema. 26 (2.8%) patients developed thrombosed stents, of which 21 (2.3%) were parital and 5 (0.5%) were complete. The patients which had partial thrombosis were managed with Plavix. 17 of these patients had resolution with clopidogrel. 4 patients with partial thrombosis and associated deep vein thrombosis were treated with full anticoagulation. 4 patients with complete thrombosis underwent successful thrombolysis, 1 patient suffered a intercerebral hemorrhage from thrombolysis and has made a partial recovery.
Conclusion:
In stent partial thrombosis is benign and may be treated with antiplatelet agents alone. Iliac vein partial thrombosis with LE DVT may be treated with anticoagulation
Thrombolysis was effective in patients with complete in stent thrombosis.