Stenting of chronic iliac vein occlusion. Is the effort justified?

Interventional recanalization has been conducted on post-thrombotically obstructed and non-thrombotically obstructed iliac veins for around 20 years. The initial devices were designed to treat occlusive arterial diseases. Since then, manufacturers have developed stents with a higher radial force and better flexibility to meet the special requirements of treating the venous system. This technological innovation has significantly increased patency rates after dilatation. Numerous studies have shown that the stenting of chronic iliac vein occlusions results in clinical improvements in pain and edema levels and helps to heal venous ulcers with low complication rates. American guidelines recommend endovenous stent implants for primary and post-thrombotic iliac vein obstruction at CEAP stages C3-C6 (recommendation level IB). The patency rate depends on the technical execution of the procedure. In principal, both ends of the stent need to be placed in healthy vein segments to ensure long-term treatment success. This means that the target group for percutaneous transluminal angioplasty of the veins is limited to patients suffering from post-thrombotic syndrome (PTS) following isolated deep vein thrombosis from the distal inferior vena cava to the inguinal ligament, and patients with non-thrombotic compression syndromes. Current epidemiological data on PTS indicate that the patient cohort profiting from interventional recanalization is relatively small. Real-world register data confirm this.