Long term follow-up of endo-vascular recanalization of chronic inferior vena cava occlusion secondary to inferior vena cava filters

Abstract

Background: The long term efficacy of endovascular recanalization for chronic iliocaval occlusion secondary to inferior vena cava (IVC) filters is unknown. The purpose of this study was to evaluate the effectiveness of endovascular recanalization and stent placement across the filter in patients with filter-associated chronic iliocaval occlusion.

Patients and methods: Seven patients (mean age 56 ± 15 yrs; seven males) with symptomatic chronic iliocaval occlusion and occluded IVC filter were included. Immediate technical success rate, long term clinical effectiveness of endovascular recanalization and patency rate of the stents were assessed.

Results: In all patients, the endovascular treatment consisted of percutaneous venous access, recanalization of the occluded iliac veins and the IVC, transluminal angioplasty and stenting of the infrarenal inferior vena cava and iliac veins with self-expanding stents. The IVC filter was not removed, but rather the stents were extended across the filter. In four of seven patients (57 %), adjunctive pharmaco-mechanical thrombolysis was performed. All patients received anticoagulation post procedure. The mean clinical follow-up was 51.1 ± 27 months. Technical success rate was 100 %. Clinical success rate with symptomatic improvement was 85.7 %; one patient developed post-thrombotic syndrome on long term follow-up despite initial symptomatic improvement. Poststenting, the primary patency rate was 85.7 % (six of seven patients) and the secondary patency rate was 100 % (seven of seven patients).

Conclusions: Endovascular recanalization with balloon angioplasty and placement of a self-expanding stent across a chronically occluded IVC filer can be performed safely and effectively for patients with symptomatic iliocaval thrombosis. An adjunctive pharmacologic-mechanical thrombolysis may be considered for selected patients.

Keywords: Inferior vana cava filter; endovascular recanalization; inferior vena cava occlusion; long term follow-up; stenting.