Comparative Patency Outcomes between Stent Configurations in Endovascular Non-malignant Iliocaval Reconstruction for...

To determine whether different stent configurations used in endovascular iliocaval reconstruction for chronic venous steno-occlusive disease result in differing patency outcomes.

A systematic review (Cochrane, Medline, PubMed, Embase) was performed for studies reporting outcomes for endovascular iliocaval reconstruction. The configurations of interest included: inverted Y, double-barrel technique, the 3-stent technique, and the skip stent technique. Individual patient data (IPD) was reconstructed using the IPDfromKM technique, in order to pool the studies' data for comparative analysis.

18549 studies were identified (11092 after manual and automatic deduplication). 11084 ineligible studies were excluded. Of the 7 included studies (258 patients in total), there were no randomized control trials available for meta-analysis. There was large variation in follow-up time (3 months - 60 months). At one-year, primary patency rates were 56% (inverted-Y), 86% (double-barrel), 83% (skip-stent), and 84% (three-stent). Secondary patency rates at one year were 100%, 94%, 98%, and 98%, respectively. IPD analysis to compare configurations showed a statistically significant difference in primary patency (p=0.012), but not secondary patency (p=0.97). No studies reported QoL data for comparison and there was heterogeneity in reported data. Minimal studies reported symptomatic outcomes.

There is limited evidence for a single technique being superior. Clinicians should utilize their preferred method with appropriate governance and follow-up when approaching the Endovascular Reconstruction of the IlioCaval Confluence (ERICC). Quality of life data is lacking as is consensus of definitions in reported data.