Diabetes, Hypertension, and Smoking Do Not Affect Outcomes of Iliofemoral Vein Stenting for Proximal Venous Outflow Obstruction

Abstract

Diabetes, hypertension, and smoking are well-recognized risk factors for peripheral artery disease, but little is known of their impact on chronic venous insufficiency (CVI). The aim of this study was to evaluate these factors in CVI patients undergoing iliac vein stent placement for chronic iliofemoral venous outflow obstruction. A clinical registry of 708 patients who underwent iliac vein stenting from August 2011 to June 2021 at a single institution was analyzed. Symptoms were quantified using Venous Clinical Severity Score and CEAP class. Both major (any intervention that included venography) and minor (superficial vein ablation) reinterventions after the initial iliac vein stenting were recorded. Univariate differences were analyzed using χ2 or Fisher exact tests for categorical variables and one-way analysis of variance for continuous variables. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. A Log-rank test was used to assess differences in reintervention-free survival. Among patients with CVI undergoing vein stent placement, the prevalence of diabetes was 23.0% (n = 163), hypertension was 51.1% (n = 362), and smoking was 22.2% (n = 157). Patients with diabetes (3.6 vs 3.4; P = .062), hypertension (3.6 vs 3.3; P < .001), and smoking (3.7 vs 3.4; P = .003) had higher CEAP scores than those without diabetes, hypertension, and smoking, respectively. Improvement in venous clinical severity score composite scores after vein stenting showed no differences postoperatively (diabetes: P = .513; hypertension: P = .053; smoking: P = .608), at 1-year follow-up (diabetes: P = .666; hypertension: P = .681; smoking: P = .745), or at 5-year follow-up (diabetes: P = .525; hypertension: P = .953; smoking: P = .146) (Table I). Diabetes (OR, 0.80; 95% CI, 0.45-1.43), smoking (OR, 1.34; 95% CI, –0.73 to 2.51), and hypertension (OR, 1.11; 95% CI, 0.63-1.95) were not associated with increased risk of major reintervention after iliac vein stent placement in the multivariate regression models (Table II). Log-rank test similarly showed no differences in reintervention-free survival for major or minor reoperations between those with and without diabetes (P = .79), hypertension (P = .14), and smoking (P = .80). Unlike in peripheral artery disease, diabetes, hypertension, and smoking have little to no impact on long-term outcomes or reinterventions after iliac vein stent placement for CVI.Table IComparison of patients with and without smoking history, diabetes, and hypertension preoperatively and postoperatively.VariablesSmoking historyP valueNo (n = 551)Yes (n = 157)PreoperativeVCSS composite10.5 (4.0)10.5 (4.3).894CEAP class3.4 (1.0)3.7 (1.1).003PostoperativeVCSS composite6.4 (3.6)6.7 (3.7).586Change in VCSS composite postoperative to preoperative3.5 (3.3)3.7 (3.3).608Reintervention1.8 (1.2)2.0 (1.6).091DiabetesP valueNo (n = 545)Yes (n = 163)PreoperativeVCSS composite10.6 (3.9)10.3 (4.5).478CEAP class3.4 (1.0)3.6 (1.2).062PostoperativeVCSS composite6.5 (3.5)6.4 (4.0).827Change in VCSS composite postoperative to preoperative3.6 (3.3)3.4 (3.2).513Reintervention1.8 (1.3)1.9 (1.2).709HypertensionP valueNo (n = 346)Yes (n = 362)PreoperativeVCSS composite10.4 (3.6)10.6 (4.5).594CEAP class3.3 (0.9)3.6 (1.2)<.001PostoperativeVCSS composite6.6 (3.5)6.4 (3.7).727Change in VCSS composite postoperative to preoperative3.9 (5.3)4.6 (5.3).053Reintervention1.8 (1.2)1.9 (1.3).174VCSS, Venous Clinical Severity Score. Open table in a new tab Table IIAdjusted and unadjusted odds of any minor and major reinterventionComparisonModelORP value95% CISmoking historyUnadjusted1.120.595(0.75-1.70)Adjusted1.340.355(0.73-2.51)DiabetesUnadjusted0.640.022(0.43-0.94)Adjusted0.80.454(0.45-1.43)HypertensionUnadjusted0.730.071(0.52-1.03)Adjusted1.110.727(0.63-1.95)CI, Confidence interval; OR, odds ratio. Open table in a new tab