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    Factors associated with difficulty in stenting the chronic iliofemoral venous obstruction

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    This article investigates the causes of technical failure during endovascular recanalization in patients with post-thrombotic syndrome and occluded iliofemoral veins. The study aims to suggest alternative techniques to improve outcomes in these challenging cases. we analyzed the data from 230 patients (274 limbs) who underwent endovascular recanalization between November 2015 and August 2020. The initial attempt was unsuccessful in 15 limbs, and the study examines the factors contributing to these failures. The causes of failure included hostile groin areas in intravenous drug abusers, prior surgeries at the occlusion site, severe stent deformity, and congenital venous aplasia. Of the 15 patients, 11 underwent a subsequent attempt, resulting in six successful recanalizations. The follow-up period for the successful recanalization group averaged 27 months, with high primary, assisted primary and secondary patency rates. The remaining five patients who had failed second recanalization attempts received conservative treatment. The study concludes that recanalization failure is rare in chronic venous obstruction patients, with severe stent deformities having the lowest chance of success. Patients with a hostile groin or prior open surgeries at the occlusion site may be considered for reintervention with a success rate of nearly 50%
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