PURPOSE: To report the immediate and midterm results of manual aspiration thrombectomy as the first thrombus removal method in the treatment of acute or early chronic arterial thromboembolism in the lower extremity. MATERIALS AND METHODS: Retrospective review of 40 limbs in 37 nonconsecutive patients between March 2006 and March 2008 (21 female [57%], 16 male; mean age, 67 +/- 10 years; age range, 42-84 years) who had percutaneous aspiration thrombectomy for lower limb arterial thromboembolism. Twenty-nine legs had acute (<14 days) and 11 legs had early chronic (15-60 days) thromboembolism. Clinical categories of limb ischemia were stage I in 12 limbs, stage IIa in 17 limbs, and stage IIb in 11 limbs. RESULTS: Technical success was achieved in 35 limbs (88%). Complete thrombus removal was achieved in 26 of 29 limbs (90%) with acute occlusions and 4 of 11 limbs (36%) with early chronic occlusions (P < 0.05, c(2) test). Amputation-free survival rate was 100% at one month, 93% at one year, and 93% at two years with Kaplan-Meier survival analysis. Freedom from symptoms of claudication or critical limb ischemia was achieved in 31 of 39 limbs (80%) at one month and 25 of 35 limbs (71%) at one year. There were three major complications and ten minor complications. CONCLUSION: Percutaneous aspiration thrombectomy is a rapid and effective way of removing thrombus in thromboembolic occlusions of the limb arteries below the inguinal ligament. It can be used in patients with acute limb ischemia (Rutherford clinical category IIb).

The aim of this study was to report technical details, procedure-related complications, and results of endovascular treatment in chronic iliac artery occlusion. Between 2001 and 2008, endovascular treatments of 127 chronic iliac artery occlusions in 118 patients (8 women and 110 men; mean age, 59 years) were retrospectively reviewed. The study was based on Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery Standards). All occlusions were treated with stent placement with or without preliminary balloon angioplasty. Kaplan-Meier estimators were used to determine patency rates. Univariate and multivariate analyses were performed to determine variables affecting successful recanalization, major complications, early stent thrombosis (</=30 days), and primary and secondary patency rates. Initial technical success was achieved in 117 (92%) procedures. Successful recanalization was obtained by antegrade approach in 69 of 77 (90%) procedures and by retrograde approach in 52 of 105 (50%) procedures (p < 0.001). Complications were encountered in 28 (24%) patients [minor in 7 patients (6%) and major in 22 patients (19%)]. One death occurred in the operative period secondary to iliac artery rupture. Early stent thrombosis was seen in eight (7%) patients. Presence of critical limb ischemia (p = 0.03), subintimal recanalization (p = 0.03), and major complication (p = 0.02) were the independent predictors of early stent thrombosis on multivariate analysis. Primary and secondary patency rates at 5 years were 63 and 93%, respectively. Presence of critical limb ischemia, TASC type C iliac lesions, combined occlusions of both common and external iliac arteries, and major complications were associated with decreased patency rates on univariate analysis, whereas these factors were not independent predictors of stent patency on multivariate analysis. In conclusion, endovascular treatment of iliac artery occlusion has a high technical success rate with favorable long-term patency rate. Success of recanalization increases with use of the antegrade approach and with the presence of a stump of artery before the occlusion.

PURPOSE: To determine the distribution of atherosclerotic peripheral artery disease (PAD) and associated risk factors in patients who have undergone pelvic and lower-limb angiography. MATERIALS AND METHODS: Records of 626 consecutive patients (88 women, 538 men; mean age, 62 years; age range, 31-85 y) with PAD were retrospectively reviewed. Severity of limb ischemia was staged according to Rutherford classification of PAD. The arterial system was divided into three segments including aortoiliac, femoropopliteal, and crural segments. PAD was defined as a greater than 50% stenosis or occlusion of any segment. Univariate and multivariate analyses were used to determine associations between segmental arterial disease and patient demographics, medical history, and angiographic findings. RESULTS: Of the 626 patients, 400 (64%) had multisegmental disease, the most common form of which was combined femoropopliteal and crural disease (25%). A significant association was found between severity of limb ischemia and distribution of PAD. Intermittent claudication was significantly associated with aortoiliac disease (odds ratio, 2.15; P <.001), whereas critical limb ischemia was associated with crural disease (odds ratio, 2.5; P =.001) on multivariate analysis. Significant associations were found between smoking and aortoiliac, femoropopliteal, and multisegment disease; between diabetes mellitus and crural disease; and between age and femoropopliteal and multisegment disease. CONCLUSIONS: PAD was multisegmental in most of the patients in this study group. Different clinical risk factors predict the involvement of different arterial segments. Severity of limb ischemia was significantly associated with the distribution of PAD.

The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

The purpose of this study was to compare the technical success and complication rates of ultrasonography-guided central venous catheterization between adult and pediatric patients which have not been reported previously. In a 4-year period, 859 ultrasonography-guided central vein catheterizations in 688 adult patients and 247 catheterizations in 156 pediatric patients were retrospectively evaluated. Mean age was 56.3 years (range, 18 to 95 years) for adults and 3.3 years (range, 0.1 to 16.3 years) for children. The preferred catheterization site was internal jugular vein in 97% of adults and 85% of children. The technical success rate, mean number of punctures, and rate of single wall puncture were 99.4%, 1.04 (range, 1-3), and 83% for adults and 90.3%, 1.25 (range, 1-5), and 49% for children, respectively. All the differences were statistically significant (p < 0.05). Complication rates were 2.3% and 2.4% for adults and children, respectively (p > 0.05). Major complications such as pneumothorax and hemothorax were not seen in any group. In conclusion, ultrasonography-guided central venous catheterization has a high technical success rate, lower puncture attempt rate, and higher single wall puncture rate in adults compared to children. Complication rates are comparable in the two groups.

PURPOSE: To retrospectively evaluate compression of the left common iliac vein as demonstrated at computed tomography (CT) in patients with iliofemoral deep vein thrombosis due to iliac vein compression syndrome (IVCS) and compare compression ratios with those of asymptomatic subjects. MATERIALS AND METHODS: Between March 2003 and June 2007, compression of the left common iliac vein by the right common iliac artery, as demonstrated with CT, in 34 patients (25 women and nine men; mean age, 51 years; age range, 21-79 years) with IVCS was retrospectively evaluated. Compression ratios were compared with those of 34 age- and sex-matched asymptomatic subjects. A t test was used to compare the compression ratios. RESULTS: The percentages of compression of the left common iliac vein were 45%-100%(mean, 74%+/- 17) for patients with IVCS and 0%-68%(mean, 28%+/- 20) for control subjects (P <.05). Of the 34 patients with IVCS, 11 (32%) had less than 70% compression and 23 (68%) had at least 70% compression. CONCLUSIONS: There was considerable overlap between the degree of compression in patients with IVCS and control subjects. Compression of the left common iliac vein was significantly more prominent in patients with lower extremity deep vein thrombosis due to IVCS when compared with control subjects. Compression in excess of 70% as demonstrated at CT can be helpful for identifying possible underlying IVCS in patients with a left lower extremity deep vein thrombosis.

OBJECTIVE: To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD). MATERIALS AND METHODS: To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%)(mean age+/-S.D.: 61.5+/-11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis (>/=60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement). RESULTS: Renal artery disease was found in 33%(207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n=60) had significant (>/=60%) renal artery stenosis. Only age and hypertension (blood pressure systolic >140mmHg or diastolic >90mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5+/-8.9 years compared with 61+/-11.2 years for patients without RAS (p<0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p=0.01). CONCLUSION: Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

Phlegmasia cerulea dolens is an uncommon but potentially life-threatening complication of acute deep vein thrombosis. It is an emergency and delay in treatment may cause death or loss of the patient's limb. Surgical thrombectomy is the recommended treatment in venous gangrene. Catheter-directed intrathrombus thrombolysis has been reported as successful, but it may require a lengthy infusion. Manual aspiration thrombectomy may clear the entire thrombus with no need for thrombolytic administration and provide rapid and effective treatment for patients with phlegmasia cerulea dolens with impending venous gangrene.

OBJECTIVE: To prospectively evaluate the technical success and immediate complication rates of temporary central catheter placement in a homogenous patient population with disorders of hemostasis. MATERIALS AND METHODS: One hundred and thirty three temporary central vein catheters inserted under ultrasound guidance in 119 patients with bleeding disorders were analyzed over a 4-year period. Patients were males (n=51; 43%) and females (n=68; 57%) with a mean age of 56.6 years (age range 18-95 years). A catheter was inserted in IJV in 129 (97%) procedures, subclavian vein in 2 (1.5%) procedures and femoral vein in 2 (1,5%) procedures. Thirty-three (24.8%) procedures were performed on bedside. Of 119 patients, 106 (89%) had only one catheter placement and the rest had had more than one catheter placement (range 1-3). RESULTS: Technical success was achieved in all patients (100%). Average number of puncture was 1.01 (range 1-2). One hundred and nineteen insertions (89.5%) were single-wall punctures, whereas 14 insertions were double-wall punctures. Eight (6%) minor complications occurred including oozing of blood around the catheter in five (3.8%) procedures, small hematoma in two (1.5%) procedure and both in one patient. There was no inadvertent arterial puncture or major complications like hemothorax or pneumothorax in any patients. CONCLUSION: US-guided placement of central vein catheters in patients with disorder of hemostasis is safe with high technical success and low complication rates. US guidance for central venous catheterization should be the preferred method in this group of patients, if available in the hospital setting.

DVT and PE contribute to at least 100,000 deaths each year. In addition, 4% of patients with PE will progress to CTEPH and PTS will affect nearly 30%. Anticoagulation alone appears inadequate to prevent PTS in many patients. Newer treatment strategies, including PCDT, appear to offer the possibility of reducing the pain, suffering and expense of PTS especially in the most severe cases. The NIH/NHLBI sponsored the ATTRACT trial, which will compare PCDT plus standard anticoagulation versus standard anticoagulation alone in patients with proximal DVT. The ATTRACT trial will enroll patients at both Miriam and RI Hospitals and is expected to add significantly to the research in this area. When successfully completed, results from the trial may guide therapy in the years ahead.

May-Thurner syndrome is a rare clinical entity involving venous obstruction of the left lower extremity. Obstruction occurs secondary to compression of the left common iliac vein between the right common iliac artery and the underlying vertebral body. Current management largely involves endovascular therapy. A review was conducted of six studies containing at least five patients with May-Thurner syndrome treated by endovascular therapy. We compiled data on 113 patients, analyzing patient demographics, treatment details, and outcome. An 18-year-old female presented 1 week after the onset of left lower extremity pain and swelling. Duplex ultrasonography revealed extensive left-sided deep venous thrombosis (DVT). Thrombolysis followed by iliac vein stent placement restored patency to the venous system, with subsequent resolution of symptoms. Review of 113 patients revealed that the majority were females (72%) presenting with DVT (77%), most of which was acute in onset (73%). Therapy consisted of catheter-directed thrombolysis and subsequent stent placement in the majority of patients, resulting in a mean technical success of 95% and a mean 1-year patency of 96%. Endovascular therapy is the current mainstay of treatment for May-Thurner syndrome. Review of the current literature supports treatment via catheter-directed thrombolysis followed by stent placement with good early results.

OBJECTIVES: The long-term outcome of catheter-directed thrombolysis (CDT) in patients with acute iliofemoral venous thrombosis (IFVT) is evaluated in this study. MATERIAL AND METHODS: Patients presenting for treatment with IFVT between June 1999 and May 2007 were considered for treatment using CDT. The following inclusion criteria were used: first episode of IFVT, age below 60 years, age of thrombus <14 days and open distal popliteal vein. Ultrasonography (US) was used to verify the diagnosis. The popliteal vein was punctured under local anaesthesia using US guidance, and a multi-side-hole catheter with tip occlusion was placed in the thrombus. A solution of r-TPA was infused either continuously or using the pulse spray technique together with heparin. Any occlusion or residual stenosis in the iliac vein system was treated by stenting. Compression stockings and anticoagulation treatment were given for at least 12 months. Patients with severe thrombophilias were treated for longer periods. The patients were assessed by colour-duplex US for assessment of patency and valve function after 6 weeks, 3, 6 and 12 months and afterwards on a yearly basis. RESULTS: A total of 101 patients with 103 extremities affected by iliofemoral venous thrombosis were included (median age; 29 years, 78 women, and 79 had left-sided thrombosis). A stent was inserted in 57 limbs. The median follow-up time was 50 months (range 3 days-108 months). At 6 years, 82% of the limbs had patent veins with competent valves and without any skin changes or venous claudication. CONCLUSION: Treatment with CDT for IFVT achieves good patency and vein function after 6 years of follow-up in this highly selected group of patients. We suggest that results from future studies should be presented as Kaplan-Meier plots using venous patency without reflux as the main outcome, since it is an early indicator of the clinical outcome.

PURPOSE:To evaluate patency and clinical outcome in patients treated with endovascular recanalization and stent placement for chronic iliac vein occlusions. METHODS:During a 14-year period (1994-2008), 59 (38 women; median age 39 years) of 62 patients with chronic occlusion of the iliac vein segment in 66 limbs were successfully treated with endovascular recanalization and stent placement. A prospectively maintained database was analyzed retrospectively to obtain information on clinical details, endovascular techniques, and outcome. RESULTS:Three (5%) procedures failed for technical reasons. Three (5%) complications occurred, 2 (3%) of which were perforations requiring transfusion and procedure termination. Initial clinical success after 6 months was achieved in 49 (83%) of the 59 patients successfully treated initially. Primary patency after a median imaging follow-up of 25 months was 67%(44/66), assisted primary patency was 75%(49/66), and secondary patency was 79%(52/66). Fifteen (23%) of 66 limbs were asymptomatic after a median clinical follow-up of 32 months, 34 (52%) limbs were improved, 13 (20%) were unchanged, and 4 (6%) were worse compared to before intervention. Actuarial primary, assisted primary, and secondary patency rates using Kaplan-Meier survival analysis were 70%, 73%, and 80%, respectively, at 5 years. CONCLUSION:Endovascular recanalization and stent placement is a safe and effective treatment for occluded iliac veins and adjacent segments. Clinical midterm results are encouraging. Recanalized and stented segments remain patent in the majority of patients after 2 years. Endovascular treatment can ease symptoms and prevent further deterioration of patients with post-thrombotic syndrome.

Summary Background: Approximately one of four patients with acute proximal deep vein thrombosis (DVT) given anticoagulation and compression therapy develops postthrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase patency and prevent PTS. Objectives: To assess short-term efficacy of additional catheter-directed thrombolysis (CDT) compared to standard treatment alone. Patients and methods: Open, multicenter, randomized, controlled trial. Patients (18 to 75 years) with iliofemoral DVT and symptoms <21 days were randomized to receive additional CDT or standard treatment alone. Iliofemoral patency after six months was investigated using duplex ultrasound and air-plethysmography assessed by investigator blinded to previous treatment. Results: 103 patients (64 men, mean age 52 years) were allocated additional CDT (n=50) or standard treatment alone (n=53). Following CDT grade III (complete) lysis was achieved in 24 and grade II (50-90%) lysis in 20. One patient suffered major bleeding and three had clinically relevant bleeding related to the CDT procedure. Iliofemoral patency after six months was found in 32 (64.0%) in CDT group vs. 19 (35.8%) controls, corresponding to an absolute risk reduction (RR) of 28.2%(95% CI: 9.7-46.7%; P=0.004). Venous obstruction was found in 10 (20.0%) in CDT group vs. 26 (49.1%) controls; absolute RR 29.1%(95% CI: 20.0-38.0%; P=0.004). Femoral venous insufficiency did not differ between the two groups. Conclusions: Additional CDT increased iliofemoral patency after six months from 36% to 64%. The ongoing long-term follow-up of this study will document whether patency is related to improved functional outcome.

OBJECTIVE: To report the long-term results of stenting for chronic ilio-caval obstructive lesions. MATERIAL AND METHODS: From January 1996 to January 2008, 89 patients (72 women, 17 men; median age 43 years) were admitted for endovascular treatment of chronic disabling non-malignant obstructive ilio-caval lesions. Patients were classified as C2 in 15 cases, C3 in 59, C4 in seven, C5 in two and C6 in six. Median preoperative venous disability score (VDS) and venous clinical severity score (VCSS) were 2 and 9, respectively. Aetiology was primary in 52 patients, secondary in 35 and congenital in two. Lesions were bilateral in seven cases, eight patients had inferior vena cava (IVC) involvement and 18 had common femoral vein (CFV) obstructive lesions. Complete occlusion was found in 30 cases. RESULTS: Technical success was achieved in 98%. The median hospital stay was 2 days. During a median follow-up of 38 months (range: 1-144 months), one patient died and five cases of thromboses occurred. Iterative stenting was performed for restenosis in six cases. Primary, assisted-primary and secondary patency rates, in terms of intention to treat, were 83%, 89% and 93%, respectively, at 3 and 10 years, with a median VDS of 1. Univariate analysis found that significant factors affecting patency were CFV involvement for primary patency and history of deep venous thrombosis (DVT) and CFV involvement for secondary patency. The last 46 patients had statistically more severe lesions than the first 43 (higher VDS, more secondary lesions, more occlusions, more stented segments, higher length of stented vein), and in spite of which patency rates are not different. CONCLUSION: Endovenous angioplasty, combined with stenting, is a sure, safe, effective and very minimally invasive technique which provides good long-term patency rates. Currently, it is recognised as the technique of choice for the treatment of ilio-caval obstructive lesions. Surgery should be proposed only in case of failure.

AIM: To assess the technical feasibility and initial success of aspiration thrombectomy as a potential alternative to lytic therapy in initial endovascular management of acute lower extremity deep vein thrombosis (DVT). MATERIALS AND METHODS: From July 2004 to October 2007, a retrospective analysis of 27 patients (male:female 5:22; mean age 59 years) with acute iliofemoral or femoropopliteal DVT of less than 2 weeks was performed. All patients underwent sonography of the lower extremities, and 13 patients underwent computed tomography (CT) venography. All patients received an inferior vena cava (IVC) filter and were initially treated with aspiration thrombectomy using the pullback technique with or without basket thrombus fragmentation. If persistent stenotic portions (>50% luminal narrowing) were noted, balloon angioplasty or stent placement was performed. Successful recanalization was defined as successful restoration of antegrade flow in the treated vein with elimination of any underlying obstructive lesion. RESULTS: The mean procedure time was 65 min (range 40-100 min). Successful initial recanalization was achieved in 24 patients (88.9%) without complications. Urokinase was required for three patients (11.1%) due to a hard thrombus remaining in the iliac vein. Of the 27 patients, 23 had residual venous stenosis in the common iliac vein or external iliac vein. Therefore, balloon angioplasty (n=23) and stent placement (n=22) was performed. The remaining four patients were treated using only aspiration thrombectomy without angioplasty or stent placement. CONCLUSION: Aspiration thrombectomy without catheter-directed thrombolysis is a safe and effective treatment for acute DVT of the lower extremities, and minimizes the risk of haemorrhagic complications.

The incorporation of endovascular interventions into mainstream clinical practice for patients with deep vein thrombosis (DVT) has been changing rapidly as a result of four major trends. First, there now is a much greater appreciation among practicing physicians of the major impact of the postthrombotic syndrome (PTS) on DVT patients' late quality of life. Second, there have been rapid advances in the methods by which thrombus can be rapidly removed using endovascular techniques, resulting in greater efficiency and treatment safety. Third, these changes together have spurred a major change in recommended DVT treatment paradigms: there is now published expert consensus that adjunctive endovascular DVT thrombolysis should be strongly considered as a first-line treatment strategy for selected patients with extensive acute proximal DVT. Finally, DVT researchers from multiple subspecialties have finally come together in a major multidisciplinary clinical trial project to subject endovascular DVT thrombolysis to the rigorous scientific testing that is needed for clinicians to be confident in its efficacy, safety, and cost-effectiveness as a first-line DVT treatment strategy. Pending the results of this and other studies, medical physicians should routinely inform DVT patients about the long-term consequences of DVT; ensure that they understand the importance of anticoagulant therapy and elastic compression stockings in preventing PTS; provide a balanced discussion of the risks, benefits, and uncertainties associated with endovascular DVT thrombolysis to patients with extensive proximal DVT; and develop collaborative clinical and research relationships with physicians experienced with endovascular DVT therapy.

OBJECTIVE: To evaluate the value of early identification and endovascular treatment of iliac vein compression syndrome (IVCS), with or without deep vein thrombosis (DVT). MATERIALS AND METHODS: Three groups of patients, IVCS without DVT (group 1, n = 39), IVCS with fresh thrombosis (group 2, n = 52) and IVCS with non-fresh thrombosis (group 3, n = 34) were detected by Doppler ultrasonography, magnetic resonance venography, computed tomography or venography. The fresh venous thrombosis were treated by aspiration and thrombectomy, whereas the iliac vein compression per se were treated with a self-expandable stent. In cases with fresh thrombus, the inferior vena cava filter was inserted before the thrombosis suction, mechanical thrombus ablation, percutaneous transluminal angioplasty, stenting or transcatheter thrombolysis. RESULTS: Stenting was performed in 111 patients (38 of 39 group 1 patients and 73 of 86 group 2 or 3 patients). The stenting was tried in one of group 1 and in three of group 2 or 3 patients only to fail. The initial patency rates were 95%(group 1), 89%(group 2) and 65%(group 3), respectively and were significantly different (p = 0.001). Further, the six month patency rates were 93%(group 1), 83%(group 2) and 50%(group 3), respectively, and were similarly significantly different (p = 0.001). Both the initial and six month patency rates in the IVCS patients (without thrombosis or with fresh thrombosis), were significantly greater than the patency rates of IVCS patients with non-fresh thrombosis. CONCLUSION: From the cases examined, the study suggests that endovascular treatment of IVCS, with or without thrombosis, is effective.

OBJECTIVES: The initial and long term outcome of stenting in the iliac vein were investigated in patients with iliac compression syndrome. METHODS: Iliac compression syndrome was diagnosed with venography and intravascular ultrasonography that demonstrated severe stenosis at the iliac venous compression site. Fourteen patients with symptomatic iliac compression syndrome were treated with stent implantation. The patency of the stents was examined at short and long term follow-up examinations. RESULTS: Thirteen patients presented with left iliac venous compression and only one patient presented with right iliac venous compression. Twelve of the 14 patients had acute deep venous thrombosis, so temporary vena cava filter implantation was performed during the procedure in these 12 patients. Procedural success was defined as less than 50% stenosis after stent implantation with good flow and without major complication (death, surgical repair for vein, or symptomatic pulmonary embolization). Procedural success was achieved in 13 of 14 patients, and these 13 patients showed improvement of symptoms. In the unsuccessful case, the compression site was resolved by stenting, but good flow was not obtained due to remaining femoral vein occlusion. The self-expandable stent was used for 6 patients, and the balloon-expandable stent was used for 8 patients. Angiographic or ultrasonographic follow up was performed in 10 patients at mean follow up of 8 months, but no restenosis was documented. CONCLUSIONS: Stent implantation for symptomatic iliac compression syndrome is a safe and effective procedure to resolve venous disease symptoms. Despite the small number of patients, long term outcome has been excellent in this study.