Inferior Vena Cava Stenting

Background and indications

Inferior vena cava (IVC) stenting is the endovascular treatment for IVC stenosis or occlusion. Indications include: Budd-Chiari syndrome (hepatic vein and/or IVC thrombosis), tumoral IVC compression (renal, hepatic, retroperitoneal tumors), post-IVC filter obstruction, and caval anastomotic stenosis post-liver transplant.

Pre-procedure assessment

Assessment includes venous CT angiography (stenosis mapping, thrombosis extent), Doppler ultrasound, and coagulation panel. Obstruction cause (thrombotic vs compressive) determines therapeutic strategy.

Procedure

Under local anesthesia and sedation, femoral and/or jugular venous access is obtained. Under fluoroscopic guidance, the stenosis is crossed and a large-caliber self-expanding stent (14-24 mm) is deployed. Balloon angioplasty may complement placement. For Budd-Chiari, heparin therapy is associated. The procedure takes 1 to 2 hours.

Results and scientific evidence

Technical success rate is 90-98%. For Budd-Chiari, IVC stenting offers clinical improvement in 80-90% of cases, delaying or avoiding liver transplantation. For tumoral obstructions, stenting offers rapid and effective symptom palliation (edema, ascites).

Risks and complications

Stent thrombosis (5-10%, reduced by anticoagulation), migration (< 2%), peri-procedural pulmonary embolism (< 1%), access site hematoma (3-5%). Long-term anticoagulation recommended.

Recovery

2-3 night hospitalization. Long-term anticoagulation. Control Doppler ultrasound at 1, 3, 6, and 12 months.

Practical information

The procedure is performed as a short inpatient stay. It is performed by a vascular interventional radiologist.