title: Endovascular stent placement for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions: a single-center study of safety, efficacy and quality-of-life improvement.
abstract: BACKGROUND
  Post-thrombotic syndrome (PTS) is a frequent complication of deep vein thrombosis (DVT) despite adequate treatment. Venous angioplasty and stent placement has been progressively used to restore and maintain venous patency in PTS patients. This study reports our single-center experience with the use of endovascular treatment for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions.
  
  
  METHODS
  A prospective mono-centric observational cohort study of PTS patients with chronic symptomatic ilio-femoral venous obstructive lesions referred for endovascular treatment was conducted from March 2012 to April 2016. Procedure consisted in recanalization, pre-dilation and self-expandable stenting of stenotic or occluded iliac and/or femoral veins. Severity of PTS, quality-of-life and treatment outcomes were assessed using Villalta scale and Chronic Venous Insufficiency Questionnaire (CIVIQ-20) at baseline and 3 months after the procedure. Imaging follow-up was based on duplex ultrasound (US) and computed tomography (CT).
  
  
  RESULTS
  Twenty-one patients (11 females, 10 males; median age, 41 years; range, 32-60) were included. Recanalization and stenting was successfully accomplished in all prime procedures, 4 patients benefitted from an additional procedure. Immediate technical success rate was 96% considering 25 procedures, performed without any complications. Median follow-up was 18 months (range, 6-30 months) with a 90.5% stent patency rate. Villalta score significantly decreased from baseline compared with 3 months after the procedure [14 (range, 11-22) and 5 (range, 1-10), respectively, P<0.0001], showing a significant decrease in the severity of PTS. CIVIQ-20 score significantly decreased from baseline compared with 3 months after stenting [48.5 (range, 39-73) and 26.5 (range, 21-45), respectively, P<0.0001] thus showing a significant improvement of quality-of-life. Post-procedural CIVIQ-20 score was significantly associated with Villalta score (95% CI, 1.53-2.95; P<0.0001).
  
  
  CONCLUSIONS
  Our results confirm the high clinical success rate and safety of endovascular PTS treatment and highlight the significant impact of stenting on the quality of life of patients with chronic symptomatic ilio-femoral venous obstructive lesions.
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Marie-Tiphaine
authors.initials: MT
authors.lastname: Falcoz
authors.affiliation: Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Falvo
authors.affiliation: Department of Epidemiology, Statistics and Clinical Research, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Aho-Glélé
authors.affiliation: Department of Biological Haemostasis and Thrombosis Treatment, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Demaistre
authors.affiliation: Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Galland
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Favelier
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pottecher
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chevallier
authors.affiliation: Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bonnotte
authors.affiliation: Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Audia
authors.affiliation: Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Samson
authors.affiliation: Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Terriat
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Midulla
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Romaric
authors.initials: R
authors.lastname: Loffroy
keywords: Ilio-femoral venous obstructive lesion; endovascular treatment; post-thrombotic syndrome (PTS); quality of life; stent placement