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Long Term Patient Benefits Seen With Iliofemoral Venous Stenting For Thrombotic And Non-Thrombotic Pathologies - A Single-institution Experience
Emily Austin, Mark Broering, Aaron Kulwicki, Matthew Recht, Adam Reichard, Jacob Shapiro, Patrick Muck.
Trihealth, Cincinnati, OH, USA.
OBJECTIVES: For patients with outflow obstructions secondary to thrombotic disease including acute Deep Venous Thrombosis (aDVT), Post Thrombotic Stenoses (PTS) and Non-thrombotic iliac vein lesions (NIVLs), venous stenting is the treatment of choice. Prior studies highlight good long term patency rates and improved quality of life with iliofemoral venous stenting in industry sponsored trials. The purpose of this study is to evaluate this institution’s experience with iliofemoral venous stenting for aDVT, PTS, and NIVLs.
METHODS: This is a retrospective review from January 2016 to March 2021 of 123 patients who underwent iliofemoral venous stenting for NIVLs and thrombotic disease. The primary end points were stent patency at 3 years and major adverse events (MAEs) at 30 days. Secondary end points included primary assisted and secondary assisted patency at 3 years, MAEs at 1 year, stent fracture, and change in VCSS scores 6 months after stenting.
RESULTS: Of 123 patients who underwent iliofemoral venous stenting, 73 patients had follow up imaging at 3 years. Stent patency at 3 years was 90.7% (p=0.099) for all patients, 93.5% for aDVT, 80% for PTS, and 90.6% for NIVLs. Rate of MAEs at 30 days was 11% (p=0.453) for all patients, 16.1% for aDVT, 10% for PTS, and 6.3% for NIVLs. Of the 73 patients, 16 required reinterventions with a primary assisted patency rate of 90%, and a secondary patency rate of 100%. The rate of MAEs at 1 year was 5.5% (p=0.192) for all patients, 9.7% for aDVT, 10% for PTS, and 0% for NIVLs. There was no evidence of stent fracture at 3 years. The median change in VCSS scores was 8 for all patients, 8 for aDVT, 13 for PTS, and 8 for NIVL.
CONCLUSIONS: Patients with venous outflow obstructions secondary to aDVT, PTS, and NIVLs have been successfully treated with iliofemoral venous stenting with high patency rates at 3 years. Primary assisted and secondary patency rates were high as well. There were low rates of MAEs at 30 days and 1 year with a decrease in VCSS scores making this a safe and effective procedure for treating iliofemoral venous outflow obstructions.
Iliofemoral Venous Stenting Patency Rates | Total | aDVT | PTS | NIVL |
| Primary Patency at 3 Years (%) | 90.4 (66/73) | 93.5 (29/31) | 80 (8/10) | 90.6 (29/32) |
| Primary Assisted Patency (%) | 90 (9/10) | 100 (3/3) | 100 (4/4) | 66.7 (2/3) |
| Secondary Patency (%) | 100 (7/7) | 100 (5/5) | 100 (1/1) | 100 (1/1) |
| Target Lesion Revascularization (%) | 93.8 (15/16) | 100 (7/7) | 100 (5/5) | 75 (3/4) |
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