Iliofemoral stenting for venous occlusive disease.
BACKGROUND
Venous hypertension is a significant cause of patient morbidity and decreased quality of life. Common etiologies of venous hypertension include deep venous thrombosis (DVT) or congenital abnormalities resulting in chronic outflow obstruction. We have implemented an aggressive endovascular approach for the treatment of iliac venous occlusion with angioplasty and stenting. The purpose of this study was to determine the patency rates with this approach at a large tertiary care center.


METHODS
All patients undergoing iliofemoral venous angioplasty and stenting over a 4-year period were identified from a vascular surgical registry. Charts were reviewed retrospectively for patient demographics, the extent of venous system involvement, the time course of the venous pathology, and any underlying cause. Technical aspects of the procedure including previous angioplasty or stenting attempts and presence of collaterals on completion venogram were then recorded. Patency upon follow-up was determined using primarily ultrasound scans; other imaging methods were used if patency was not clear using an ultrasound scan.


RESULTS
A total of 36 patients (40 limbs) were stented from January 2005 through December 2008. Of these patients, 27 were women (75%). Both lower extremities were involved in 4 patients. Thrombolysis was performed in 19 patients (52.8%). Thrombosis was considered acute (<30 days) in 13 patients (38%). The majority of patients who had a recognized underlying etiology were diagnosed with May-Thurner syndrome (15 patients; 42%). In 9 patients, an etiology was not determined (25%). The mean follow-up time period in the study population was 10.5 months. One stent in the study occluded acutely and required restenting. Primary patency rates at 6, 12, and 24 months were 88% (75.2-100), 78.3% (61.1-95.4), and 78.3% (61.1-95.4), respectively. Secondary patency rates for the same time frames were 100% (100.0, 100.0), 95% (85.4, 100.0), and 95% (85.4, 100.0). Better outcomes were seen in stenting for May-Thurner syndrome and idiopathic causes, whereas external compression and thrombophilia seemed to portend less favorable outcomes (P < .001). Symptomatic improvement was reported in 24 of 29 patients (83%) contacted by telephone follow-up.


CONCLUSIONS
Iliofemoral venous stenting provides a safe and effective option for the treatment of iliac venous occlusive disease. Acceptable patency rates can be expected through short-term follow-up, especially in the case of May-Thurner syndrome. Further experience with this approach and longer-term follow-up is necessary. Thrombophilia workup should be pursued aggressively in this population, and further studies should be undertaken to determine the optimal length of anticoagulation therapy after stent placement.
Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. titusj@ccf.org
Jessica M
JM
Titus
Mireille A
MA
Moise
James
J
Bena
Sean P
SP
Lyden
Daniel G
DG
Clair
D000293:Adolescent; D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D000925:Anticoagulants / Q000008:administration & dosage; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D004334:Drug Administration Schedule; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010690:Phlebography; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D015912:Thrombolytic Therapy; D019851:Thrombophilia / Q000150:complications / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
D000925:Anticoagulants