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Contralateral deep-vein thrombosis in lliac vein stenting – Incidence, etiology, and prevention

Iliocaval venous obstruction is a significant contributor to venous hypertension. Recanalization and stenting of chronic deep venous obstructions are minimally invasive and have been proven to be safe and effective with low complication rates over the past few decades. Common iliac vein (CIV) stents are usually extended into the inferior vena cava (IVC) to some extent to ensure adequately that key areas of stenosis are adequately treated. This may lead to contralateral CIV jailing and increase the risk of contralateral deep-vein thrombosis (DVT). The reported incidence of contralateral DVT after CIV stent placement from different studies varies from 1% to 15.6%. The predicted risk factors are noncompliance with anticoagulation, underestimation of the postthrombotic venous disease, preexisting IVC filter, incorrect stent placement, preexisting contralateral internal iliac vein thrombosis, malignancy, and thrombophilia. Literature suggests that the use of intravascular ultrasound, newer dedicated stents, and Z-stent modification reduces the incidence of contralateral DVT. Precise stent deployment technique and proper attention to other hematological risk factors are the key to preventing this complication. This article will review the incidence, mechanism, risk factors, and technical aspects of how to avoid this unfortunate complication. We will also review the newer dedicated venous stents.