Venous Interventions

Session: Educational Exhibit Presentations - Station 11: Venous Interventions

Imaging and Intervention for Radiation-Induced Iliofemoral Stenosis and Occlusion

Monday, March 6, 2023

5:50 PM – 5:55 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Nathan Loudon, MD

Interventional Radiology Resident
University of Michigan

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

WS

William Sherk, MD

Clinical Assistant Professor, Interventional Radiology
University of Michigan Hospital
AL

Amber Liles, MD, MPH

Clinical Assistant Professor
University of Michigan
MK

Minhaj S. Khaja, MD, MBA, FSIR (he/him/his)

Professor of Radiology & Cardiac Surgery
University of Michigan
David M. Williams, MD

Professor of Radiology and Internal Medicine (Cardiology)
University of Michigan Health System

Disclosure(s):

Nathan Loudon, MD: No financial relationships to disclose

William Sherk, MD: No financial relationships to disclose

Amber Liles, MD, MPH: No financial relationships to disclose

Minhaj S. Khaja, MD, MBA: No relevant disclosure to display

David M. Williams, MD: No financial relationships to disclose

Learning Objectives:

Identify cross-sectional imaging findings of radiation-induced iliofemoral venous stenosis or occlusion.

Correlate cross-sectional imaging with venographic and intravascular ultrasound findings.

Discuss potential complications and management strategies for recanalization of iliofemoral venous obstruction related to radiation therapy.

Background:

Radiation therapy has a well-established role in cancer care. Venous stenosis and occlusion are complications which can be seen in patients who undergo radiation as part of their cancer therapy. While SVC obstruction in the post-radiation setting is a commonly described phenomenon, iliofemoral occlusion is a less frequently discussed but important complication that affects many patients following pelvic radiation therapy.

Clinical Findings/Procedure Details:

Common imaging features include hourglass-shaped venous stenosis or occlusion of variable length seen on cross sectional and angiographic imaging.

On intravascular ultrasound, extensive perivascular echogenicity may be seen and blend into the surrounding tissues, correlating with the area of post-treatment change.

Procedural considerations include the selection of a stent with high radial force in order to mitigate the risk of restenosis given the extensive perivenous fibrosis present in these patients. Given the friable nature of tissue that has previously been exposed to radiation, there may be a higher rate of intraprocedural vascular injury; therefore, operators should be able to recognize and respond to intraprocedural complications promptly. Careful thought must be given to the choice between deployment of a stent or a stent-graft.

Conclusion and/or Teaching Points: Many patients have a history of radiation therapy for cancer care. A familiarity with the common imaging features seen in post-radiation venous stenosis and their procedural implications can equip interventional radiologists to improve their care of this patient population.