In the past, open surgical techniques such as thrombectomy and bypasses were the treatments of choice for acute and chronic venous occlusive disease of the iliocaval vein segments, but the results were often disappointing. With the introduction of endovascular techniques in the 1990s, open techniques were widely replaced by endovascular interventions. Proper preoperative imaging with computed tomography and magnetic resonance phlebography has become an important part of procedure planning, but phlebography by direct puncture with contrast injection in the immediate proximity of the iliofemoral segment is still the most informative diagnostic method. Catheter-directed thrombolysis with recanalization and stenting of underlying chronic obstructions is becoming the treatment of choice for patients with acute iliofemoral thrombosis, as conservative treatment is not satisfactory for preventing postthrombotic syndrome. Recanalization of chronic iliac vein occlusions with balloon angioplasty and stenting can reestablish normal venous flow in the iliac veins and inferior vena cava and relieve symptoms in the majority of treated patients. New treatment modalities offer stimulating options for patients not treated adequately either by medical or open surgical therapy.
Subject classification (UKÄ)
- Cardiac and Cardiovascular Systems
- Radiology, Nuclear Medicine and Medical Imaging
- Postthrombotic syndrome
- Iliofemoral thrombosis
- Venous recanalization