267 - Thinking Beyond the Iliacs: Recanalization of Chronically Occluded Femoropopliteal Veins Improves Post-Thrombotic Syndrome

Tuesday, April 14, 2026

3:18 PM - 3:27 PM ET

Presenting Author(s)

MM

Mira Malavia, MD

IR-DR Resident
Stanford University, United States

Author/Co-author(s)

MH

Matthew L. Hung, MD

Assistant Professor of Radiology
Stanford University School of Medicine, United States
Andrew Kesselman, MD, RPVI

Clinical Associate Professor
Stanford Medicine, United States
Lawrence Hofmann, MD, FSIR

Division Chief Interventional Radiology
Stanford University Medical Center, United States

Purpose: To assess the safety and efficacy of recanalizing chronically occluded femoral (FV) and/or popliteal (PV) veins in treating patients with post-thrombotic syndrome (PTS) and patent ipsilateral iliac veins.

Materials and Methods: This was a single-center retrospective study from 2016-2025 of 21 patients (mean age 55 years, 14 males, 7 females) who underwent venous recanalization for PTS secondary to chronic occlusion of the FV and/or PV with patent ipsilateral iliac veins. Baseline clinical characteristics, procedural details including technical success and adverse events, and subsequent clinical outcomes were assessed. Technical success was defined as the restoration of in-line flow from the popliteal vein to the iliac veins. Pre- and post-intervention Villalta scores were compared using a Wilcoxon signed-rank test.

Results: The mean body mass index was 31 ± 4. Five patients (24%) had a known hypercoagulable comorbidity. Five patients (24%) had prior ipsilateral iliac vein interventions but had persistent PTS despite patency of the iliac veins. The median [IQR] pre-intervention Villalta score was 13 [11-17]. Venoplasty was performed in all patients most commonly to 10 mm in the FV (15/21, 71%) and 8 mm in the PV (9/21, 43%). Adjunctive techniques such as thrombectomy and/or thrombolysis were performed in 4 patients (19%). Technical success was achieved in 20 patients (95%). There were no severe procedural adverse events. Of the 20 patients in whom technical success was achieved, 6 required re-intervention for recurrent thrombus (6/20, 30%). Of the 6 repeat interventions, 4 were successful in restoring in-line flow from the popliteal vein to the iliac veins (4/6, 67%). Overall, the primary and secondary patency rates for recanalized femoropopliteal veins were 70% and 90% after median imaging follow-up of 9.2 months. In 14 patients (70%) who had pre- and post-intervention Villalta scores available for comparison, venous recanalization significantly improved PTS symptoms (pre-intervention: 13 [11-16], post-intervention: 5 [4-8.5], p = 0.002).

Conclusion: Recanalization of isolated chronically occluded femoropopliteal veins is technically feasible, safe, and significantly improves symptoms of PTS.