Contemporary Outcomes of Elective Iliac Vein Stenting in Chronic Venous Occlusive Disease

Abstract

Patients with chronic venous occlusive disease present with a spectrum of findings ranging from leg edema to severe nonhealing ulceration and venous claudication. Angioplasty with iliac vein stenting has been shown to significantly improve clinical outcomes. Previous studies have included thrombotic and nonthrombotic lesions in analysis of outcomes in iliac vein stenting for chronic venous disease. Our objective was to evaluate our approach to recanalization and stenting in the treatment of thrombotic venous occlusive disease and to report the outcomes. A prospectively maintained database was retrospectively reviewed. All patients with symptomatic thrombotic iliac vein lesions between 2008 and 2015 were analyzed. Nonthrombotic iliac vein lesions were excluded from analysis. Criteria for intervention included thrombotic stenosis or occlusion of the iliac vein or vena cava in the setting of symptomatic chronic venous disease of clinical, etiologic, anatomic, and pathophysiologic (CEAP) class 3 or greater. Presenting CEAP score, postintervention CEAP score, primary and secondary patency, wound healing, and clinical outcomes were recorded. Of the 32 patients evaluated, 38.7% had a hypercoagulable disorder; 67.7% were prescribed anticoagulation before intervention. Symptoms included pain/swelling (100%); venous claudication (80.7%); or CEAP class 3 (78%), class 4/5 (9%), or class 6 (13%). All patients were presenting with either subacute (>30 days [37.5%]) or chronic (>90 days [62.5%]) thrombosis. Successful intervention was performed in 31 (97%) by angioplasty/stent, with adjunctive lysis in 62.5%. Overall clinical improvement occurred in 87.5% and a decrease in CEAP score in 65.4%. Complete clinical resolution was obtained in 46.8% of all patients. Healing of ulceration occurred in 60% of patients with a median heal time of 3 months (compared with 12 months median preoperatively). Complications included three early reocclusions and no mortality or pulmonary embolism or clinically significant hematoma. Primary and secondary 1-year patency was 64% and 71% overall (mean follow-up, 14.7 months). Treatment of chronic venous occlusive disease with iliac vein stenting is associated with excellent 1-year patency rates, healing of venous ulcers, and a significant reduction in symptoms and CEAP score.