Primary patency after venous stenting best in NIVL patients, study finds

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A recent study concludes that non-thrombotic iliac vein lesion (NIVL) patients have better primary patency after venous stenting than patients with venous thrombotic disorders. Olivier Espitia (CHU de Nantes, Nantes, France) and colleagues report this main finding from a multicentre cohort study in the European Journal of Vascular and Endovascular Surgery (EJVES).

The authors detail that it was their aim to assess primary stent patency predictive factors in three groups of patients with history of lower limb vein thrombosis: NIVL, acute deep vein thrombosis (aDVT) and post-thrombotic syndrome (PTS).

The investigators included consecutive patients from January 2014 to December 2020 with history of lower leg vein stenting from seven hospitals in the study. They note that all patients received an iliac or common femoral venous stent and had at least a six-month follow-up available with stent imaging. The team reported the anticoagulant and antiplatelet therapy strategies employed after venous stenting and compared these between the three patient groups.

In their results section, Espitia et al state that the study included 377 patients in total, comprising 134 in the NIVL group, 55 in the aDVT group and 188 PTS patients, and that median follow-up was 28.2 months (interquartile range 16, 47). The authors report in EJVES that primary patency was statistically significantly higher in the NIVL group (99.3%) compared with the PTS group (68.6%; p<0.001) and the aDVT group (83.6%; p=0.002).

In addition, the researchers note that PTS patients received a statistically significantly greater number of stents (p<0.001) and had more stents below the inguinal ligament (p<0.001).

Finally, Espitia and colleagues relay the findings that discontinuation of antiplatelet therapy at the last assessment was 83.6% for NIVL, 100% for aDVT, and 95.7% for the PTS group (p<0.001). Discontinuation of anticoagulation therapy at the last assessment, they add, was 93.2% for NIVL, 25% for aDVT, and 70.3% for the PTS group (p<0.001). “The only predictor of worse primary patency in the aDVT group was long-term anticoagulation before stenting,” the authors highlight.


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