Departments of 1Vascular Surgery and 2Interventional Radiology, St. Antonius

l l Purpose: To report the midterm results of endovascular recanalization of chronic long-segment (.5 cm) occlusions of the inferior vena cava (IVC) with stent placement. Methods: Nine patients (5 men; median age 30 years, range 14±58) with disabling com-plaints for more than 6 months caused by IVC occlusions were treated by endovascular recanalization. Mean occlusion length was 11 cm (range 6±22); some occlusions extended to the iliac (n53) or common femoral (n52) veins. All procedures were performed under local anesthesia via a bilateral femoral (n57) or popliteal (n52) approach. In 3 patients, combined access to the brachial or internal jugular vein was necessary. Patients with acute-on-chronic thrombosis were pretreated with urokinase. After guidewire recanalization, the chronic occlusions were predilated and self-expanding Wallstents were implanted. Results: The initial technical and clinical success was 100%. The venous clinical severity score (pain, venous edema, in¯ammation, and active ulceration) decreased from a mean 862 to 561 after the procedure. Over a median follow-up of 9 months (mean 21, range 4± 110), 3 patients died. One rethrombosis occurred, and an asymptomatic restenosis wa