Iliac vein stent placement

The placement of an iliac venous stent helps to keep a vein in the pelvis open when a blockage significantly impedes blood return. This may be considered when symptoms and tests confirm that this venous disorder has clinical implications and may benefit from treatment.

What does the placement of an iliac venous stent involve?

The iliac veins carry a large proportion of the blood returning from the legs and pelvis to the abdomen. When one of these veins is compressed, narrowed or blocked, resistance to venous return increases and pressure in the veins situated below may rise.

A venous stent is a tubular structure made of a metal mesh that expands within the vein to keep the affected segment open. It is inserted via catheters through a venous puncture and remains in place permanently.

The procedure is carried out from within the blood vessels and does not require a large surgical incision. Nevertheless, it is a vascular procedure that requires a well-founded indication, precise planning and follow-up care.

What venous conditions can it treat?

One of the best-known causes of iliac obstruction is May-Thurner’s syndrome. In its classic form, the right iliac artery compresses the left iliac vein against deep structures in the pelvis and may impede the return of blood from the leg.

When this compression has clinical implications, it can contribute to the development of swelling, pain, a feeling of heaviness, skin changes or, in certain circumstances, deep vein thrombosis.

Obstruction may also arise as a consequence of a previous thrombosis. After the clot has resolved, the vein may remain narrowed due to internal scarring or organised thrombotic material, forming part of what is known as post-thrombotic syndrome.

These two situations are not equivalent. Localised non-thrombotic compression usually has different characteristics from a vein damaged following extensive thrombosis and may require a different management strategy and different expectations.

When might a stent be considered?

Treatment may be considered when the venous obstruction is reasonably linked to persistent symptoms or significant functional impairment. Some people experience progressive swelling of one leg, a feeling of heaviness, pain when standing, or difficulty walking.

In more advanced cases, persistent skin changes or venous ulcers that are slow to heal may develop. Where the blockage contributes significantly to these problems, restoring venous drainage may form part of a strategy aimed at reducing pressure in the limb.

Stents may also be used in certain cases of iliofemoral thrombosis, a condition affecting the deep veins of the pelvis and upper leg. After treating the clot, significant residual narrowing may be identified, hindering blood return and requiring further treatment.

In the aftermath of a previous thrombosis, it may be necessary to reconstruct longer venous segments. These procedures are usually more technically complex, and the clinical response may be less predictable than in cases of localised compression.

How to decide whether the obstruction requires treatment

The assessment begins by understanding what is actually causing the symptoms. The specialist looks at when they first appeared, how they change throughout the day and to what extent they interfere with activities such as walking, working or standing.

A history of thrombosis, previous procedures, pregnancies, hormonal treatments and other factors that may affect venous circulation are also reviewed.

Swelling and pain in a leg can have various causes. These include superficial venous insufficiency, lymphoedema, certain musculoskeletal or neurological conditions, and some heart, kidney or liver problems.

For this reason, the decision is not based solely on whether it is technically possible to implant a stent. The aim is to determine whether opening that vein can lead to a reasonable and proportionate clinical improvement, taking into account the alternatives, the risk of bleeding or thrombosis, and the feasibility of continuing treatment and follow-up checks.

Tests to investigate venous obstruction

Venous Doppler ultrasound is usually one of the first tests carried out. It allows the flow in the veins of the legs to be assessed and any changes detected that may suggest an obstruction in the pelvis.

Venous CT angiography and venous magnetic resonance imaging provide a more comprehensive view of the iliac veins, the structures that may be compressing them, and the alternative pathways that the circulation has developed.

During the procedure, venography may be used, whereby contrast medium is injected into the vein and X-ray images are taken to visualise its course and assess the obstruction.

Intravascular ultrasound

In certain cases, intravascular ultrasound (IVUS) is also used. A small ultrasound probe is guided through the vein, allowing the vein’s calibre and the characteristics of the lesion to be assessed directly.

This information can help to determine the extent of the blockage more accurately and to select the appropriate diameter and length of the stent. Venography and IVUS provide different types of information and can be used in a complementary manner, depending on the individual case.

Preparation before the procedure

Before the procedure, blood tests, kidney function, coagulation and regular medication are reviewed. Particular attention is paid to anticoagulant and antiplatelet treatments during planning, as these influence both the risk of bleeding and the prevention of new clots.

These medicines must not be stopped, started or altered without medical advice. The team will determine the appropriate management based on your history of thrombosis, the type of blockage and the planned procedure.

It is also important to disclose any history of reactions to contrast medium, kidney disease, bleeding episodes, recent infections, and pregnancy or the possibility of pregnancy. Instructions regarding fasting and medication on the day of the procedure depend on the type of sedation or anaesthesia and on individual circumstances.

How an iliac vein stent is implanted

The procedure is carried out in a setting equipped for image-guided vascular interventions. The type of anaesthesia depends on the complexity of the procedure: many procedures can be performed under local anaesthesia and sedation, whilst others require deep sedation or general anaesthesia.

After selecting the access site, a small puncture is made in a vein. A vein in the groin, behind the knee, in the neck or at another site may be used, depending on the patient’s anatomy and the segment to be treated.

Catheters and guidewires are inserted through this access point and advanced to the blocked area under image guidance. Venography and, where indicated, intravascular ultrasound help to precisely define the lesion and select the size and position of the device.

Once the blockage has been passed, a balloon may be used to initially dilate the vein. The stent is then deployed in the affected segment and, where necessary, expanded again using a balloon to ensure adequate support against the vein wall.

Before completing the procedure, the team checks that the device correctly covers the lesion and that venous flow passes through the treated segment satisfactorily.

The duration depends on the complexity of the obstruction. Localised compression and extensive venous reconstruction following thrombosis are different procedures in terms of both planning and duration of the procedure.

Sensations during and after the procedure

The needle insertion and administration of the local anaesthetic may cause brief discomfort. During the dilation of the vein, some people may experience temporary pressure or pain in the pelvis, groin, abdomen or lower back.

The administration of contrast medium may cause a temporary sensation of warmth. After the procedure, you may experience tenderness or a small bruise at the puncture site, as well as tiredness or pelvic and lower back discomfort during the first few days.

What benefits can the treatment bring?

When obstruction is a major cause of the symptoms, restoring the vein’s diameter can facilitate blood return and reduce the venous pressure build-up in the leg.

Improvement may be evident as a reduction in swelling and the sensation of heaviness, less pain, or greater ease when walking and standing. Where venous hypertension contributes to an ulcer, improving drainage can aid healing, alongside compression and specific wound care.

Improvement is not always immediate. Some symptoms may subside shortly after treatment, whilst persistent oedema or chronic skin changes may take longer to resolve.

The response also depends on the type of lesion. A localised obstruction without prior thrombosis may progress differently from a vein with extensive scarring and post-thrombotic damage.

Technical success and clinical improvement

It is important to distinguish between three concepts. Technical success indicates that the stent has been successfully placed and that the vein remains open; patency describes the device’s ability to maintain blood flow over time; and clinical improvement means that symptoms and functional capacity actually improve.

These three outcomes do not always follow the same course. A vein may remain open, yet some discomfort may persist where there is also lymphoedema, reflux in other veins or musculoskeletal problems.

Risks and potential complications depending on the type of obstruction and procedure

The placement of an iliac venous stent is a vascular procedure and may be associated with potential complications. The type and likelihood of these occurring depend on the cause and extent of the blockage, any history of thrombosis, the procedure performed and the individual’s clinical characteristics.

Initial discomfort may include temporary pain in the pelvis, back or groin, and bruising at the puncture site. Bleeding, a reaction to the contrast medium, infection or impaired kidney function may also occur in susceptible individuals.

One of the issues monitored during follow-up is whether the stent may narrow or a thrombus may form inside it. When this occurs, symptoms may return and it may be necessary to adjust medication or perform a new procedure to restore blood flow.

Other possible complications include vein injury, extension of a thrombosis, pulmonary embolism, displacement of the device or obstruction of a neighbouring vein.

The extent of the risk cannot be summarised by a single figure applicable to everyone. Localised venous compression without a history of thrombosis and extensive reconstruction of damaged veins following thrombosis represent different clinical situations.

Medication following stent placement

Following the procedure, treatment with anticoagulants, antiplatelet agents or a combination of both may be prescribed for a specified period.

The treatment plan depends in particular on whether thrombosis is present or has occurred, the type of blockage treated, and the individual balance between the risk of new clots and the risk of bleeding.

There is no single standard of care applicable to all people with a venous stent. For this reason, both the type of treatment and its duration are tailored to the individual.

It is important to follow the prescribed treatment plan and to seek advice before changing your medication or taking any new medicines, supplements or other products that may increase the risk of bleeding.

Recovery and return to normal activities

Recovery depends on the complexity of the procedure and the pre-existing condition of the veins. A planned procedure to treat localised compression may follow a different course from a reconstruction carried out following extensive thrombosis.

Mobility is resumed as soon as it is safe to do so, and gradually increasing walking is usually part of the recovery process. During the initial period, it may be necessary to limit strenuous physical exertion or activities that increase pressure on the puncture site.

Depending on the venous condition treated, compression stockings may be recommended to help control swelling. Their use and duration are tailored to each individual case.

A return to work, driving, travelling and sport is determined based on the patient’s progress, their anticoagulant treatment and the complexity of the procedure.

Follow-up after implantation

Treatment does not end once the procedure is complete. Follow-up appointments allow us to assess how swelling, pain, walking ability and tolerance to medication are progressing.

Doppler ultrasound can be used to check blood flow through the treated segment. If symptoms return or there are concerns about how the stent is functioning, further imaging tests may be required.

If improvement is less than expected, the scan can check whether the device remains open and whether there are any narrowings at its ends or inside it. Other possible causes of pain or swelling are also investigated, such as post-thrombotic syndrome, insufficiency of other veins, lymphoedema or musculoskeletal disorders.

Depending on the results, medication may be adjusted, compression therapy modified, other venous disorders treated, or a new procedure considered.

Situations requiring specific assessment

History of thrombosis

Previous episodes of thrombosis may have left scarring and extensive blockages in the veins. This situation affects both the complexity of treatment and the expectations and planning of subsequent medication.

Coagulation disorders or active cancer

Conditions that increase the tendency to form clots and certain oncological processes may influence the risk of further thrombosis and the antithrombotic strategy.

Kidney disease or contrast allergy

Renal function and any history of reactions to contrast media are assessed prior to the procedure, as these may affect the tests used and the planning of the procedure.

Pregnancy and desire to conceive

Pregnancy, the possibility of pregnancy and hormonal treatments form part of the assessment. In young people, particular consideration is also given to the permanent nature of the device and the need for long-term follow-up.

Pelvic pain

Certain iliac venous obstructions may contribute to congestion in the pelvic veins. However, chronic pelvic pain may also have gynaecological, gastrointestinal, urinary, musculoskeletal or neurological causes.

Stent placement is considered when the assessment identifies a clinically significant obstruction and there is a reasonable link between this abnormality and the symptoms.

Alternatives to venous stent placement

The approach depends on the cause of the obstruction and the impact it has.

When venous compression is discovered incidentally and causes no symptoms, clinical monitoring may be sufficient. Where symptoms are mild or have different causes, treatment may include adapted physical activity, avoiding prolonged periods of immobility, elevating the legs or using compression where indicated.

If deep vein thrombosis is present, anticoagulation usually plays a central role. In certain cases of iliofemoral thrombosis, techniques aimed at removing or reducing the clot may also be used before assessing whether an obstruction remains that would justify stent placement.

It may also be necessary to treat other venous conditions that contribute to the symptoms. Open surgery is usually reserved for selected situations where endovascular treatment is not possible or appropriate.

Signs requiring medical assessment

Following the procedure, you should seek medical advice if there is a sudden or marked increase in swelling or pain in one leg, persistent bleeding at the puncture site, or a rapidly enlarging bruise.

A fever accompanied by redness, discharge or progressive pain at the access site also requires consultation. Noticeable changes in the colour or temperature of the leg should also be assessed.

The sudden onset of shortness of breath, chest pain, coughing up blood, severe dizziness or loss of consciousness may indicate a thromboembolic complication and requires urgent medical attention.

Specialists involved

The clinical pathway begins with a specialist assessment designed to determine whether there is a deep vein obstruction, whether this explains the symptoms, and which approach can restore venous return with reasonable clinical benefit.

At the Publio Cordón Memorial Hospital, the Abdominal Compression Syndromes and Venous Thrombosis Unit is the specialist unit for this procedure. It focuses on the investigation and treatment of complex disorders of deep venous return, including May-Thurner syndrome, iliac compression, complex deep vein thrombosis and post-thrombotic syndrome. The unit itself includes venous stenting amongst the expertise of its specialists and specifically offers iliac venous stenting.

The unit forms part of Angiology and Vascular Surgery, the speciality responsible for the diagnosis, treatment and follow-up of arterial and venous vascular disorders. Its structure includes separate units for complex vascular disease and prioritises an individual assessment before recommending endovascular or surgical treatments.

Interventional Radiology may be involved depending on the care pathway and the nature of the procedure, particularly in image-guided vascular techniques. This speciality forms part of the hospital’s range of services.

Where deep sedation or general anaesthesia is used, Anaesthetology and Intensive Care is involved in the pre-procedure assessment and in monitoring during the procedure.

Depending on the patient’s medical history and the cause of the obstruction, Haematology, Internal Medicine, Gynaecology or other specialities may also be involved. The composition of the team is adapted to take account of the presence of thrombosis, coagulation disorders, pelvic pain or other associated conditions.

Medical information for general guidance

This factsheet aims to help you understand what an iliac vein stent is, in which situations it may be considered, how a deep vein obstruction is investigated, how the procedure is carried out and what follow-up care is required after implantation. It also explains why the presence of compression on an imaging scan does not, on its own, determine the need for treatment.

At Publio Cordón Memorial Hospital, we believe it is important for medical information to be accurate, understandable and useful in guiding each person through their care journey. Our specialists devote part of their work to explaining conditions, tests and treatment options in an accessible way, helping patients and their families to better understand each stage and to participate with greater confidence in decisions about their health. This commitment to knowledge and public outreach is also part of our dedication to research and the advancement of medicine.

The information contained in this factsheet describes the general principles of iliac vein stent placement. The indication must be determined on a case-by-case basis, taking into account symptoms, the cause and extent of the obstruction, a history of thrombosis, the patient’s general condition, the risk of bleeding and thrombosis, and the available alternatives.