Best management options for chronic iliac vein stenosis and occlusion

BackgroundIliac vein stenting technology is rapidly emerging as a minimally invasive alternative to traditional open venovenous bypass procedures for iliac vein stenoses and chronic total occlusions.MethodsPeer-reviewed publications meeting eligibility criteria were retrieved and reviewed from public domain databases.ResultsReviewed reports encompass ∼1500 patients. Evidence quality was judged moderate, with a grade 1B recommendation (benefits outweigh risks) for patients with disabling symptoms in whom conservative therapy had failed. A grade 2B recommendation was assigned for patients with less severe symptoms. Iliac vein stenting is safe, with negligible morbidity (<1%). Patency was 90% to 100% for nonthrombotic disease and 74% to 89% for post-thrombotic disease at 3 to 5 years. Clinical relief of pain was 86% to 94%, and relief from swelling was 66% to 89%. From 58% to 89% of venous ulcers healed. Procedural success in recanalization of chronic total occlusions was 83% to 95%. Hybrid techniques for complex cases are in evolution.ConclusionsIliac vein stenting is emerging as a safe and effective alternative to traditional open surgery to correct iliac vein obstruction.