Venous Stents Placed for Postthrombotic Syndrome: The Role of Inflow Disease on Patency

To identify the risk of deep femoral vein (DFV) and/or femoral vein (FV) inflow disease on venous stent patency loss in postthrombotic syndrome (PTS).

This single-center retrospective study included limbs with iliofemoral and iliocaval stents for PTS. Single-vessel and double-vessel inflow disease were defined on the basis of imaging of possible postthrombotic changes in the DFV/FV. Endpoints were 1-year primary patency (open stents without reintervention) and secondary patency (open stents with or without reintervention). Event-free survival was estimated using Kaplan-Meier methods (log-rank test). Univariate and multivariate binary logistic regression were conducted to estimate the effects of various covariates on the risk of primary patency loss.

Eighty limbs were included: 37 limbs (46%) without inflow disease, 26 limbs (33%) with single-vessel inflow disease, and 17 limbs (21%) with double-vessel inflow disease. One-year primary patency was higher for limbs without inflow disease (89.2%) than for limbs with single-vessel inflow disease (57.7%; P = .002) and double-vessel inflow disease (47.1%; P < .001). No significant differences were found for secondary patency. Inflow disease predicted 1-year primary patency loss (odds ratio [OR], 7.17; 95% CI, 2.16-23.78; P = .001; univariate). Inflow disease of the FV was the only significant predictor after multivariate analysis (OR, 10.99; 95% CI, 2.59-46.74; P = .001).

Inflow disease increases the risk of patency loss within the first year after treatment with venous stents for PTS. Inflow should be discussed with patients to improve decision making and expectations.