Abstract:Background and Aims Chronic iliocaval venous occlusion secondary to long-term inferior vena cava filter (IVCF) implantation is associated with severe post-thrombotic syndrome (PTS). Although balloon angioplasty combined with stent implantation is recommended, long-term patency remains suboptimal and stent-related complications are not negligible. This study aimed to evaluate the efficacy and safety of repeated balloon dilatation combined with final drug-coated balloon (DCB) angioplasty in patients with chronic iliocaval venous occlusion.Methods This single-center retrospective study enrolled 72 patients with chronic iliocaval venous occlusion treated between January 2022 and December 2024. Sixty-two patients who completed a standardized protocol of three balloon dilatation sessions were included in the final analysis. At 6 months postoperatively, patients were classified into a patency group or an occlusion group based on computed tomography venography (CTV). Clinical outcomes, including IVC patency, filter retrieval rate, limb circumference, VCSS and Villalta scores, PTS severity, and CTV-derived morphologic parameters, were compared.Results The technical success rate was 86.1% (62/72). At 6 months, iliocaval patency was achieved in 43 patients (69.4%). The filter retrieval rate was significantly higher in the patency group than in the occlusion group (100% vs. 78.9%, P=0.002). Patients in the patency group showed significant reductions in limb circumference, improvements in VCSS and Villalta scores, and decreased PTS severity (all P<0.05). CTV revealed significant increases in the cross-sectional area of the mid and proximal segments of the IVC (all P<0.05). No severe perioperative complications were observed (all P>0.05).Conclusion Repeated balloon dilatation combined with DCB angioplasty is a safe and effective treatment for chronic iliocaval venous occlusion, providing favorable short-term patency and significant clinical improvement while potentially avoiding stent-related complications.