Criteria to predict mid-term outcome after stenting of chronic iliac vein obstructions (PROMISE trial).

Hügel, U; Khatami, F; Muka, T; Koeckerling, D; Schindewolf, M; Bernhard, S M; Kucher, N; Baumgartner, I (2023). Criteria to predict mid-term outcome after stenting of chronic iliac vein obstructions (PROMISE trial). Journal of vascular surgery. Venous and lymphatic disorders, 11(1), 91-99.e1. Elsevier 10.1016/j.jvsv.2022.05.018

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BACKGROUND

Endovenous stent placement has become a first-line approach to prevent post-thrombotic syndrome in patients with chronic post-thrombotic obstruction (PTO) or non-thrombotic iliac vein lesions (NIVL) if conservative management fails. This study aims to identify factors associated with loss of patency to facilitate patient selection for endovenous stenting.

METHODS

We retrospectively analyzed 108 consecutive patients following successful endovenous stenting for chronic vein obstruction performed at a single institution from January 2008 to July 2020. Using multivariable logistic regression, we explored potential predictive factors for loss of stent patency, including baseline demographics, postthrombotic changes as well as peak flow velocities measured in the common femoral vein (CFV), deep femoral vein (DFV) and femoral vein (FV) using duplex ultrasound.

RESULTS

Mean follow-up duration was 41 ± 26 months and participants had a mean age of 47.4 ± 15.4 years with 46.3% women. Ninety (83.3%) patients had PTO and 18 (16.7%) had NIVL, predominantly due to May Thurner syndrome. Loss of patency occurred in 20 (18,5%) patients, all treated for PTO. Comorbidities, side of intervention and sex did not differ between patients with occluded and patent stents. Stent occlusion was more common with increasing number of stents implanted (p < 0.001) and with distal stent extension into and beyond the CFV (p < 0.001). Preinterventional predictive factors for stent occlusion were lower duplex ultrasound peak velocity in the CFV (OR 7.52 95% CI 2.54 - 22.28; p < 0.001) and FV (OR 10.75 95% CI 2.07 - 55.82; p < 0.005), as well as post-thrombotic changes in the DFV (OR 4.51 95% CI 1.53 - 13.25; p = 0.006) and FV (OR 3.62 95% CI 1.11 - 11.84; p = 0.033). Peak velocities of ≤ 7 cm/s (IQR 0-20) in the CVF and ≤ 8 cm/s (IQR 5-10) in the FV were significantly associated with loss of patency CONCLUSIONS: Insufficient venous inflow as assessed by low peak velocities in the CFV and FV as well as postthrombotic findings represent reliable risk predictors for stent occlusions, warranting their inclusion into the decision-making process for invasive treatment of PTO.

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