Extension of iliac vein stent into the profunda femoral vein for salvage.

Background: The extension of iliac vein stents into the common femoral vein is often required to correct stenoses found at or near the inguinal ligament. Very rarely, an extension of the iliac stent into the profunda femoris vein may be required because of severe disease at the femoral trijunction. Profunda extension of iliac vein stents is a rare but useful technique for salvage. Our experience with extensions of iliac vein stents into the profunda femoris vein is described.

Methods: A search of our electronic medical records identified 20 limbs (0.75%) among a total of 2641 stented limbs (years 2006-2017) in whom the iliac vein stent was extended into the profunda femoris vein. Patients had been followed at 6 weeks, 3 months, 6 months, and yearly thereafter following the index procedure. Routine follow-up consisted of a detailed clinical evaluation, including the Venous Clinical Severity Score, visual analogue pain scale assessment, and edema grading by physical examination. Stent surveillance was performed at the follow-up visits. The iliac vein stent was declotted if needed and then extended into the profunda femoris vein at the same sitting. Antegrade access of the profunda femoris vein was preferred by direct puncture near the lesser trochanter or through a popliteal approach when a profunda-popliteal connection was present. An internal jugular access was used when an antegrade approach failed.

Results: Stent extension into the profunda was a secondary procedure after the initial iliac-common femoral vein stent failed in 17 of 20 limbs (85%). In three limbs (15%), the profunda extension was carried out at the initial iliac vein stent procedure because there was severe stenosis at the femoral confluence. One or more reinterventions after profunda extension were required in 50% of the limbs to maintain secondary patency or functionality. Fifteen of 20 limbs (75%) with profunda extensions remained patent on long-term follow-up. The median duration of secondary patency of stents that remained patent and those that occluded, and overall were 23 months, 3 months, and 10 months, respectively. Thirty percent of stents remained patent at 5 years.

Conclusions: The extension of an iliac vein into the profunda femoris vein is a rarely required but useful procedure for stent salvage and symptom relief. Corrective reinterventions are often required but can result in long term patency extending to many years.