Indications for stenting during thrombolysis

Abstract

Success after treatment with catheter-directed thrombolysis of deep venous thrombosis (DVT) in the iliofemoral vein segment is among other factors based on the stenting procedure of persistent obstructive lesions. This means opening of a chronic occlusion or stenotic appearance in the iliac vein in the so-called iliac vein compression syndrome also known as the May–Turner syndrome. It is demonstrated that restoration of the outflow tract for the entire lower limb is essential for an optimal result in the short run and to avoid the post thrombotic syndrome later on. The stents available until now have been constructed for the arterial system, but stents designed for veins are under testing. It is important that a stent is flexible with radial force to overcome the external compression, curved system and caliber difference along the vein in this low-pressure system. Balloon dilatation alone has now place in the vein structure due to wall collapse after deflation, but is only used in connection with the stenting procedure. Some technical aspects are described in details as well the considerations about the anticoagulation and flow accelerating maneuver under and after the procedure. The proportion of inserted stents varies in the published materials, which is a major cause of the varying results.