Technical details and clinical outcomes of transpopliteal venous stent placement for postthrombotic chronic total occlusion of the iliofemoral vein.
OBJECTIVE
To evaluate the technical aspects and early clinical results of stent placement for managing postthrombotic chronic total occlusion (CTO) of the iliofemoral vein through ipsilateral popliteal access.


METHODS
A retrospective analysis of 110 patients (44 men; mean age, 51 y; 118 limbs; 102 left limbs) with postthrombotic CTO of the iliofemoral vein treated with stent placement in a single institution from January 2007-December 2011 was conducted. All occlusions were initially accessed via ipsilateral popliteal veins under the guidance of venography or ultrasonography. Technical aspects, quality of life, stent patency, and Villalta scores were recorded at follow-up evaluation. Risk factors of in-stent restenosis and early in-stent thrombosis were evaluated using Cox proportional hazards regression model.


RESULTS
Percutaneous recanalization was successful in 112 of 118 limbs (95%). The mean duration of the procedure was 43 minutes (range, 10-120 min). The quality of life and Villalta scores were significantly improved (P < .01). The 3-year primary, assisted primary, and secondary cumulative stent patency rates were 70%, 90%, and 94%. During a median follow-up period of 25 months (range, 1-52 mo), the relief rates of severe leg pain (visual analog scale > 5) and severe leg swelling (grade 3) were 72% (49 of 68) and 70% (64 of 91), respectively, and the healing of ulcers was successful in 78% (36 of 46) of the cases. After stent placement, the limbs with visible remaining collateral circulation had a higher rate of early in-stent thrombosis (22.5% vs 6.1%; P = .007). The patients with long stents extending below the inguinal ligament had a higher rate of in-stent restenosis (hazard ratio = 1.77-6.5; P = .0146).


CONCLUSIONS
Transpopliteal venous stent placement is an effective, safe, and feasible method of managing postthrombotic CTO of the iliofemoral vein. The stent extending below the inguinal ligament is the major risk factor of in-stent restenosis. The visible remaining collateral circulation after stent placement may indicate persistent hemodynamically significant stenosis.
Department of Vascular Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Number 639 Zhi Zao Ju Road, Shanghai 200011, China.
Kaichuang
K
Ye
Department of Vascular Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Number 639 Zhi Zao Ju Road, Shanghai 200011, China.
Xinwu
X
Lu
Department of Vascular Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Number 639 Zhi Zao Ju Road, Shanghai 200011, China. Electronic address: jiangme2013@163.com.
Mi'er
M
Jiang
Department of Vascular Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Number 639 Zhi Zao Ju Road, Shanghai 200011, China.
Xinrui
X
Yang
Department of Vascular Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Number 639 Zhi Zao Ju Road, Shanghai 200011, China.
Weimin
W
Li
Department of Vascular Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Number 639 Zhi Zao Ju Road, Shanghai 200011, China.
Ying
Y
Huang
Department of Vascular Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Number 639 Zhi Zao Ju Road, Shanghai 200011, China.
Xintian
X
Huang
Department of Vascular Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Number 639 Zhi Zao Ju Road, Shanghai 200011, China.
Min
M
Lu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; 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; D015999:Multivariate Analysis; D010690:Phlebography; D054070:Postthrombotic Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016016:Proportional Hazards Models; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency