Coronary Artery Disease Does Not Influence Outcomes of Iliac Vein Stenting

Abstract

Although coronary artery disease (CAD) is a well-known prognosticator for worse outcomes of peripheral artery revascularization, the influence of CAD on the outcomes of lower extremity venous intervention is unknown. Our objective was to determine the impact of CAD on patient symptoms and reintervention rates after iliac vein stenting. We analyzed patients at a large tertiary care institution undergoing iliac vein stenting from August 2011 to June 2021. The venous clinical severity score was used to quantify symptoms. We stratified patients into two cohorts: those with CAD at the time of index procedure (CAD+) and those without (CAD−). Major reoperation was defined as any procedure using venography and minor reoperation as endovenous sclerotherapy or laser ablation. The two cohorts were compared with the 1-tailed independent samples t test for continuous variables and χ2 tests for categorical variables. Univariate and multivariate odds ratios (OR) of minor and major reintervention were determined using logistic regression models. Kaplan-Meier log-rank analysis was used to assess reintervention-free survival. Among 634 patients, we identified 76 (12.0%) CAD+ and 558 (88.0%) CAD−. The CAD+ group was significantly older, had a larger mean body mass index, and a larger mean CEAP class (Table). In addition, CAD+ patients had significantly higher rates of diabetes, hypertension, smoking history, and cancer (Table). CAD+ patients were also more likely to have an active venous leg ulcer at the time of iliac vein stent. The OR for a patient needing major reintervention was significantly higher for the CAD+ cohort on univariate analysis (OR: 1.93 [95% confidence interval [CI]: 1.06-3.39], P = .025), but only trended toward significance on multivariate analysis (OR: 1.79 [95% CI: 0.93-3.35], P = .072). The OR for any reoperation, major or minor, did not differ significantly between cohorts on univariate (OR: 1.12 [95% CI: 0.66-1.94], P = .686) or multivariate analysis (OR: 1.51 [95% CI: 0.85-2.74], P = .166). The CAD+ cohort had a larger mean number of reoperations, but the difference was not significant (2.1 vs 1.8, P = .128). The change in venous clinical severity score from the time of the index vein stent procedure did not significantly differ between the two cohorts at any follow-up time point in the 6 years after iliac vein stent (Table). Although CAD has a detrimental effect on the outcomes of peripheral artery disease interventions, this study indicates that CAD has no such impact on the outcomes of iliac vein stents.TablePreoperative characteristics, perioperative details, and postoperative outcomes of coronary artery disease (CAD)+ vs CAD− cohortsVariableCAD− (n = 558)CAD+ (n = 76)P valueDemographics and comorbidities Age (SD)60.3 (13.4)67.8 (10.7)<.001 Sex: male219 (39.4%)35 (46.7%).28 Diabetes105 (18.8%)38 (50.0%)<.001 HTN63 (82.9%)63 (82.9%)<.001 BMI (SD)26.2 (5.1)29.4 (7.5)<.001 Smoking Hx104 (18.6%)23 (30.3%).026 Cancer Hx51 (9.1%)20 (26.3%)<.001Perioperative details VCSS composite (SD)10.7 (3.7)11.4 (5.1).164 CEAP class mean (SD)3.5 (1.0)3.8 (1.4).037 Stent positionUnilateral224 (40.1%)33 (43.4%).673Bilateral334 (59.9%)43 (56.6%) Number of stents placed (SD)2.2 (1.0)2.1 (1.0).32Postoperative outcomes Days of follow-up (SD)770.8 (676.9)1001.1 (865.7).012 Number of total reoperations (SD)1.1 (1.3)1.4 (1.5).078 Number of reoperations in patients w/ ≥1 reoperation (SD)1.8 (1.2)2.1 (1.4).128 Univariate OR major reoperation1.93 [95% CI: 1.06-3.39].025 Multivariate OR major reoperation1.79 [95% CI: 0.93-3.35].072 Univariate OR any reoperation1.12 [95% CI: 0.66-1.94].686 Multivariate OR any reoperation1.51 [95% CI: 0.85-2.74].166 ΔVCSS 1st postoperative visit (SD)3.6 (4.4)3.3 (4.4).509 ΔVCSS 1-year follow-up (SD)6.4 (5.4)5.7 (6.9).289 ΔVCSS 2-year follow-up (SD)7.4 (5.6)7.7 (6.3).7 ΔVCSS 3-year follow-up (SD)8.2 (5.3)7.7 (5.7).406 ΔVCSS 4-year follow-up (SD)8.8 (4.9)8.5 (5.9).538 ΔVCSS 5-year follow-up (SD)9.1 (4.8)9.0 (5.4).839 ΔVCSS 6-year follow-up (SD)9.4 (4.7)9.1 (6.2).61BMI, Body mass index; CEAP, Clinical, Etiology, Anatomic, Pathophysiology; CI, confidence interval; HTN, hypertension; OR, odds ratio; SD, standard deviation; VCSS, venous clinical severity score. Open table in a new tab