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David M. WILLIAMS
Department of Radiology, University of Michigan, Ann Arbor, MI, USA
Chronic occlusion of the iliac veins and inferior vena cava (IVC) is a source of significant morbidity to often otherwise healthy patients, but can be successfully managed with percutaneous recanalization and stenting. This article is an update of a recent review of iliocaval reconstruction, with an emphasis on ongoing changes in medical imaging and techniques of medical management of the patient with venous stents.1 The ideal patient desires to be physically active, is at least four months past acute iliocaval thrombosis, and has a patent common femoral vein and hepatic vein-IVC confluence. Duration of occlusion has not affected our own technical success of recanalization, but may, by predisposing the patient to recurrent DVT, affect long term patency by degrading the size and number of inflow vessels. Secondary patency rates at four years can be as high as 70-90%.2, 3 We anticipate that even higher success rates will follow ongoing evolutions in device design (stents with appropriate diameter, length, radial conformity to conduits of varying diameter, and resistance to compression); better understanding of the biological interaction of stent, veins, and the coagulation system; improved navigation systems to cross longer occluded segments resistant to guidewire passage; and improved methods of securing medical compliance with anticoagulation, especially in young or socially isolated patients.