Stent Extension below the Common Femoral Vein in Extensive Chronic Iliofemoral Venous Obstructions

Abstract Purpose To analyze whether primary venous stent placement into 1 dominant inflow vein peripheral to the common femoral vein (CFV) confluence is feasible. Materials and Methods Retrospective review was performed of 14 consecutive patients who underwent primary venous stent placement into veins peripheral to the CFV between 2013 and 2016. Mean patient age was 49 years; 6 (43%) patients were women. All patients had successful deep venous stent placement with brisk contrast flow through the stent. Patients had primary percutaneous stent placement when postthrombotic changes extended peripherally to the femoral confluence but a trabeculation-free area in the deep femoral vein (DFV) could be identified. Based on imaging findings, the DFV had to be considered the prominent inflow vein with normal anatomy. Femoral vein, DFV, and collateral inflow were minimally impaired owing to postthrombotic scarring or trabeculations. Results Primary, assisted primary, and secondary patency rates were 92% at a median follow-up of 481 d (range, 411–792 d). Venous Clinical Severity Score decreased from a mean of 8.9 to 6.4 ( P  = .03). The Villalta scale decreased from a mean of 11.7 to 4.3 ( P  = .003). Before intervention, venous claudication was present in 92% and remained in 38% after intervention ( P  = .016). Conclusions Stent placement through the femoral confluence into a dominant inflow vein is a promising option in a carefully selected group of patients.