Clinical outcomes of endovascular reconstruction for symptomatic iliocaval obstruction: a follow-up study

Background Iliocaval obstruction causes severe post-thrombotic syndrome (PTS) and impairs quality of life. Purpose To evaluate endovascular treatment efficacy for symptomatic iliocaval obstruction in PTS. Material and Methods A total of 17 patients underwent iliocaval venous reconstruction with stents between 2017 and 2022. All had bilateral iliac vein involvement; five presented with acute iliofemoral thrombosis and 12 with chronic iliocaval obstruction. All 17 patients had lower limb edema; nine patients reported lower limb pain (three acute iliofemoral thrombosis and six PTS) and four had active ulceration (all PTS). The technical results, adverse events, follow-up, and outcomes were documented. Results All patients received successful iliocaval reconstruction with stents in a kissing configuration, with successful outcomes. Over a mean follow-up of 46.5 ± 16.7 months (final follow-up in April 2025), all four patients with baseline venous ulcers achieved complete healing, and no new or recurrent ulcerations were observed. Significant clinical improvement was observed, with mean Villalta scores reducing from 17.6 ± 5.1 at baseline to 3.9 ± 1.6 at 1 month postoperatively ( P <0.001). At final follow-up, only two patients had symptom recurrence (mean Villalta score = 6.1 ± 4.7), with no significant change from the 1 month ( P = 0.5). Reintervention for stent stenosis occurred in 35.3%. Primary patency rates were 82.4% (12 months), 70.6% (24 months), and 64.2% (36 months); secondary patency rates reached 94.1% (12 months), 94.1% (24 months), and 82.4% (36 months). Conclusion Endovascular interventions for iliocaval obstruction are safety and effectiveness, with excellent patency rates achieved.