Clinical Assessment of Endovascular Stenting Compared with Compression Therapy Alone in Post-thrombotic Patients with Iliofemoral Obstruction.
OBJECTIVE
The study aimed to evaluate the clinical results of stent placement in post-thrombotic patients with iliofemoral obstruction compared with results in those treated with elastic compression stockings (ECS).


METHODS
A retrospective analysis of post-thrombotic patients with iliofemoral obstruction was conducted in a single institution from January 2007 to December 2012. Duplex ultrasound and selective phlebography were performed in patients with chronic venous disease and previous deep venous thrombosis (DVT). Post-thrombotic syndrome (PTS) with iliofemoral vein obstruction (Villalta score ≥10) was diagnosed in 216 patients. Among these, 122 patients were treated by stent placement, and the remaining 94 patients were treated conservatively with 30-40 mmHg ECS therapy. Technical success, stent patency rates, and complications were recorded after the interventions. Results including Villalta score, pain, edema, ulcer, and popliteal vein reflux were assessed in both groups.


RESULTS
Percutaneous iliofemoral venous stenting was successful in 116 of 122 patients (95.1%) without major complications. Follow up periods ranged from 3 to 58 months (median 21 months). Cumulative primary, assisted primary, and secondary stent patency rates at 3 years were 68.9%, 79.0%, and 91.6%, respectively. Among patients with severe PTS, the Villalta score decreased significantly with endotreatment, compared to the score of those treated by ECS therapy (16.12 ± 4.91 vs. 10.98 ± 5.89, p < .01). However, there was no significant score improvement between the two therapies in patients with moderate PTS (6.59 ± 2.37 vs. 5.75 ± 3.03, p = .22). There was a significantly higher 24 month recurrence free ulcer healing rate in the endotreatment groups (86.6% vs. 70.6%, p < .01). Both edema and pain improved significantly in the two groups. The popliteal vein reflux rate showed no significant change after endotreatment.


CONCLUSIONS
Endovascular treatment is a safe, effective, and feasible method to correct the iliofemoral obstruction of PTS. Only post-thrombotic patients with severe PTS as assessed by the Villalta score appear to benefit from the endovascular treatment.
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
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M
Yin
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
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H
Shi
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
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K
Ye
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
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X
Lu
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
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W
Li
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
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X
Huang
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China.
M
M
Lu
Department of Vascular Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China. Electronic address: Jiangme2014@gmail.com.
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M
Jiang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D053828:Stockings, Compression; D013927:Thrombosis / Q000628:therapy*; D016896:Treatment Outcome
Elastic compression therapy; Endovascular treatment; Post-thrombotic syndrome; Venous reflux disease