Factors Associated with Contralateral Deep Venous Thrombosis after Iliocaval Venous Stenting

Abstract

Stent placement across the iliocaval confluence from the left CIV is associated with a low but definite rate of contralateral iliac vein thrombosis. Acute DVT, pre-operative contralateral IIV thrombosis, pre-existing IVC filters, and anticoagulation non-compliance are significant risk factors.

Study on the Patency of the Contralateral Iliac Vein After Stenting Across the Iliocaval Confluence With an Experimental In Vivo Model

“…With the accumulated experience of intervention treatment of iliac vein occlusion, many studies suggest that contralateral venous thrombosis should not be ignored after the stent is positioned in the IVC. The incidence of contralateral venous thrombosis was approximately 1.1% to 2.7% 8,9,10 It is reported that the incidence of contralateral iliac vein thrombosis will increase due to the following factors: hypercoagulable state, contralateral internal iliac vein thrombosis, placement of vena cava filters before iliac vein stenting, and nonstandard anticoagulation therapy. 8,9 In our previous experimental study, we observed that when the iliac vein stent was entered into the IVC and completely covered the contralateral iliac vein ostium, intimal hyperplasia occurred in the stent strut covering the ostium of the contralateral iliac vein in the short term but did not affect the contralateral blood flow.…”

“…The incidence of contralateral venous thrombosis was approximately 1.1% to 2.7% 8,9,10 It is reported that the incidence of contralateral iliac vein thrombosis will increase due to the following factors: hypercoagulable state, contralateral internal iliac vein thrombosis, placement of vena cava filters before iliac vein stenting, and nonstandard anticoagulation therapy. 8,9 In our previous experimental study, we observed that when the iliac vein stent was entered into the IVC and completely covered the contralateral iliac vein ostium, intimal hyperplasia occurred in the stent strut covering the ostium of the contralateral iliac vein in the short term but did not affect the contralateral blood flow. 3 However, in the present study, we extended the observation period to 12 months after stenting and found that the bare stent covering the ostium of the contralateral iliac vein was covered by the proliferating intima, which had partially transformed into mature endothelial cells.…”

“…Especially in patients with thrombotic iliac vein lesions, the incidence of contralateral venous thrombosis is significantly increased if there are high-risk factors for thrombosis, such as hypercoagulability of the blood, mural thrombosis of the IVC, and non-standardized anticoagulant therapy. 9,12 However, after the endovascular treatment of nonthrombotic iliac vein lesions, the proportion of the contralateral iliac vein thrombosis is very low 6,12,13 even though the stent is positioned in the IVC.…”

When Technology Exceeds its Application: The First Reported Reconstruction of the Iliocaval Confluence Using an Aortic Endograft

“…In this case of subacute iliocaval occlusion, the size of the residual thrombus burden was too great for an uncovered bare metal stent to be used. Using uncovered stents within the iliocaval confluence would also increase the likelihood for contralateral iliac vein and post-procedural deep vein thrombosis to occur [9]. Furthermore, a covered aortic stent graft was used to reduce the risk of excluded thrombus penetration through the stent interstices, as would be the case in an uncovered stent.…”

“…Another is the area of thrombotic damage. For example, endovenous stenting within the iliocaval confluence has been reported to cause contralateral iliac vein and post-procedural deep vein thrombosis [9]. However, both challenging anatomical areas, such as the iliocaval confluence, and extensive thrombotic occlusion can be addressed when considering venoplasty and venous reconstruction in chronic or acute iliocaval disease, according to recently documented novel interventional approaches.…”