Factors associated with patency loss after iliocaval and iliofemoral venous stenting

The factors influencing patency loss after iliocaval and iliofemoral venous stenting remain incompletely understood. We therefore conducted a systematic review and meta-analysis to synthesize the available evidence.

PubMed, Embase, and Cochrane Library were searched to December 2025. Studies reporting associations between potential risk factors and stent outcomes were included. Data were synthesized narratively, and random-effects meta-analyses with Hartung-Knapp adjustment were performed when comparable multivariable-adjusted estimates were available.

A total of 49 studies were included, predominantly involving retrospective cohorts. The meta-analysis suggested that post-thrombotic disease, stent extension across or below the inguinal ligament, and hyperlipidemia were associated with an increased risk of patency loss, whereas increasing age showed a modest inverse association with patency loss. The narrative evidence suggested that greater anatomical disease extent was associated with poorer stent patency, whereas the evidence regarding impaired venous inflow was heterogeneous and varied according to the disease phenotype, anatomical segment, and inflow definition. Pooled analyses did not identify statistically significant associations of sex, stent length, or number of stents with patency loss. Evidence regarding anticoagulation discontinuation and adjunctive antiplatelet therapy was insufficient and inconsistent.

Patency loss after iliocaval and iliofemoral venous stenting appears to be associated with the disease phenotype, higher anatomical disease burden, and stent landing strategy. Venous inflow impairment may also be associated with poorer stent patency, although the evidence was heterogeneous. The predominantly retrospective evidence precludes causal inference. Prospective studies with standardized definitions and robust adjustment are needed to improve risk stratification and optimize post-stenting management.