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Three-Year Outcomes, Risk Factors for Restenosis After Stenting for DVT Combined with Iliac Vein Compression Syndrome
Lin Zhang1, Chuli Jiang1, Zheng Chen1
1Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
Pharmacomechanical catheter-directed thrombolysis (PCDT) and stenting effectively treat iliofemoral deep venous thrombosis (DVT) with iliac vein compression syndrome (IVCS), showing low post-thrombotic syndrome rates. Key predictors of restenosis include prior DVT and stent placement location.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Hematology
Background:
- Acute iliofemoral deep venous thrombosis (DVT) combined with iliac vein compression syndrome (IVCS) presents a complex clinical challenge.
- Pharmacomechanical catheter-directed thrombolysis (PCDT) and stenting offer a potential treatment modality for this condition.
Purpose of the Study:
- To evaluate the safety and efficacy of PCDT and stenting for acute iliofemoral DVT secondary to IVCS.
- To identify predictors of stent restenosis and assess the incidence of post-thrombotic syndrome (PTS).
Main Methods:
- A cohort of 254 patients with acute proximal DVT and IVCS treated with PCDT and stenting between 2017 and 2022 was retrospectively analyzed.
- Primary and secondary patency were assessed using duplex ultrasound (DUS).
- The Villalta score was used to evaluate PTS morbidity, and Cox regression models identified risk factors for stent restenosis.
Main Results:
- The study achieved high primary patency rates: 92.5% at 1 year, 85.4% at 3 years, and 82.4% at 5 years.
- The overall incidence of stent restenosis was 14.2%, with acute thrombosis being a major cause, often linked to anticoagulant discontinuation.
- Independent risk factors for restenosis included previous DVT history and stent placement across the inguinal ligament. The overall PTS rate was 19.3%.
Conclusions:
- PCDT with stenting is a safe and effective treatment for iliofemoral DVT secondary to IVCS, associated with low rates of PTS.
- Previous DVT history and stent placement across the inguinal ligament are significant predictors of stent restenosis.
- Stent restenosis commonly occurs within the first year and is frequently associated with acute thrombosis resulting from interrupted anticoagulation.
Abstract:
This study aimed to evaluate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) and stenting for treating acute iliofemoral deep venous thrombosis (DVT) combined with iliac vein compression syndrome (IVCS), and to identify the predictors of stent restenosis. Patients with acute proximal DVT combined with IVCS underwent PCDT and stenting from January 2017 to December 2022 were enrolled. Primary and secondary patency were assessed by duplex ultrasound (DUS). The morbidity of postthrombotic syndrome (PTS) was assessed by the Villalta score. Risk factors for stent restenosis were assessed using univariate and multivariate Cox regression models. Total of 254 patients were included. The mean follow-up time was 36.06 ± 17.66 months. The primary patency rates at 1 year, 3 years, and 5 years were 92.5%±1.7%, 85.4%±2.4%, and 82.4%±2.9%, respectively. The incidence of stent restenosis was 14.2%. Discontinuation of anticoagulants within one year [hazard ratio (HR) = 5.03; P = .048] was the factor associated with acute in-stent thrombosis. Previous DVT history (HR =2.29; P = .037) and stent placement across the inguinal ligament (HR =6.70; P < .001) were identified as independent risk factors significantly associated with stent restenosis. The overall PTS rate was 19.3%. PCDT with stenting is safe and effective for patients with iliofemoral DVT secondary to IVCS, leading to low rates of PTS. Previous DVT history and stents placed across the inguinal ligament may be predictors of stent restenosis. Furthermore, stent restenosis typically occurs within one year and is mainly caused by acute thrombosis due to discontinuation of anticoagulants.
