Endovenous bypass is an option in symptomatic patients with unsalvageable iliac vein stents.

Stent occlusion after stenting for chronic iliofemoral venous disease has an incidence of around 3% to 12% in the literature. The reasons for such occlusion vary, with patient and stent-related factors playing a role. One stent-related issue leading to stent occlusion is the use of undersized stents. Although undersized nitinol stents can be fractured and relined, this is not an option with a woven stent (eg, Wallstent). With an undersized, occluded woven stent, an option would be to bypass the occluded stent. This case report outlines the author's experience in such a setting where a patient presented with an undersized, occluded iliofemoral venous stent with severe quality-of-life impairing symptoms, and an endovenous bypass was created around the occluded stent column using Wallstent-Z stent combination. Nine months on, the patient remains significantly better with a patent stent.