A study presented at the American Venous Forum (AVF; 14–17 February, New Orleans, USA) suggests that secondary interventions for primary iliac vein stenting are “associated with good outcomes,” with a rate of 10.2% reported.
Aiya Aboubakr (Mount Sinai Hospital, New York, USA) explained to AVF delegates that the study was designed to investigate the incidence, operative findings and outcomes of secondary interventions in primary iliac vein stenting for chronic proximal venous outflow obstruction.
The study enrolled 490 iliac vein stenting patients between October 2013 and June 2016 treated for chronic proximal venous outflow obstruction. The mean age of those enrolled was 60.8 years (range 18–92 years) and 57.6% were female. Follow-up was completed in 93.3% of patients with a mean follow-up of 308.6 days.
Initial interventions were performed via a bilateral greater saphenous or common femoral vein access using venogram and intravascular ultrasound. The stents used with unilateral or bilateral iliac stents. All stents used were wallstents—18mm for male patients and 16mm for female patients. Secondary interventions were required in 10.2% (n=50) of patients. The mean age of these patients was 61.45 years (range 19–92) and 58% were female—a similar makeup to the original, larger group. The mean time to second intervention was 328 days. Most (56%, n=28) of these reinterventions were due to recurrence of symptoms following initial surgery, 24% (n=12) were due to development of new symptoms, and 20% (n=10) were due to the persistence of the original symptoms.
Aboubakr reported a series of intraoperative findings, categorised at the time of second intervention. Stent migration was observed in 8% (n=4) of patients and acute deep vein thrombosis/thrombosis in 12% (n=6). Most common was the development of an additional lesion (ie. stenosis in a native iliac vein proximal or distal to the original lesion) was seen in 50% (n=25) of patients. Stenosis within the stent (stent stenosis or isolated, focal in-stent thrombus) was reported in 16% (n=8) of cases and impairment of flow in the contralateral vessel in 12% (n=6). The majority (80%, n=40) of reinterventions consisted of the placement of a new stent, 14% (n=7) were catheter pharmomechanical thrombectomy and 6% (n=3) were isolated balloon angioplasty. “Significant symptomatic improvement” was reported in 90% (n=45) of these cases, Aboubakr said, while 2% (n=1) saw transient improvement and 8% (n=4) no improvement at all.
“The major outcomes are the significant symptomatic improvement in 90% of patients, with only two patients experiencing transient improvement,” Aboubakr said. “We established that the secondary intervention rate at 10% for chronic proximal venous outflow obstruction. We were able to identify distinct intraoperative findings that could be targets for quality improvement, and lastly reintervention is associated with good outcomes.