Stent patency in patients with advanced chronic venous disease and nonthrombotic iliac vein lesions

Abstract

ObjectiveMidterm patency results of iliac vein stents placed for nonthrombotic iliac vein lesions (NIVLs) are not widely known. Previously published studies involving large series of patients with iliac vein stent placement have failed to clearly demonstrate the outcomes for patients with NIVLs and advanced disease. To further study this issue, we reviewed our series of 268 iliac vein stents placed for NIVLs. MethodsRetrospective analysis was performed of 210 patients who underwent common or external iliac vein angioplasty and stent placement procedures between January 2013 and December 2014. Only patients with Clinical, Etiology, Anatomy, and Pathophysiology classification scores of C3, C4, or C5 were included. Patients were excluded if they had either active ulcer disease or signs of post-thrombotic lesions at initial venography or intravascular ultrasound (IVUS). Ultrasound-guided puncture was performed of the femoral or common femoral vein at the discretion of the surgeon. This was followed by ascending venography. IVUS was used in cases in which a definite stenosis was not appreciated on initial ascending venography. Balloon angioplasty and stents were applied across lesions. After the procedure, patients were instructed to use clopidogrel 75 mg daily. Patency of the stents was assessed during a follow-up visit with abdominal venous duplex ultrasound scans. The length of the patients' follow-up and stent patency rates were based on the last previous duplex ultrasound scan available. ResultsA total of 268 procedures were performed in 210 patients. Bilateral lower extremity stent placements were required in 58 patients; 173 (64.6%) procedures were performed in women. The average age of our patients was 72 ± 15 (standard deviation) years. Of the 268 procedures, 144 (53.7%) were performed in the left lower extremity. The Clinical, Etiology, Anatomy, and Pathophysiology classification of lower extremity venous disease was 58%, 30%, and 12% for C3, C4, and C5, respectively. Our average follow-up period was 437 days (median, 499 days; range, 1-1060 days). Patients were observed for >6 months, 1 year, and 2 years in 71.3%, 57.1%, and 28.7% of cases, respectively. During this period, 4 of the 268 (1.5%) limbs experienced in-stent thrombosis. Primary stent patency of 98.7%, 98.3%, and 97.9% was noted at 6 months, 1 year, and 2 years of follow-up, respectively. ConclusionsOur midterm patency rates for iliac vein stents placed in patients with advanced chronic venous disease demonstrated excellent (98.5%) results. Furthermore, with IVUS assistance, we have clearly documented the average area of iliac venous segments as well as the most common locations of the stenoses.