Association of Concomitant Disease in the Profunda and Femoro-Popliteal Veins to Cumulative Patency and Re-Intervention Rates Following Ilio-Femoral Venous Stenting of Limbs with Postthrombotic Occlusion

Background: Ilio-femoral stent patency is inferior in post-thrombotic disease compared with non-thrombotic venous obstruction. The aim of this study was to examine whether decreased inflow to the stent, caused by intraluminal obstructive disease, was associated with greater risk of re-intervention and inferior long-term patency outcomes. Method(s): Consecutive patients (2012-2017) receiving a nitinol venous stent for post-thrombotic disease were included for analysis. Pre-operative ultrasound was used to identify femoral vein (FV), profunda vein (PV), and/or popliteal vein (POPV) intraluminal scarring and/or residual thrombosis, and categorised into one of 3 groups: absence of disease; disease in a single inflow vessel; or disease in more than one inflow vessel. Stent patency was assessed using duplex ultrasonography post-intervention, and re-interventions performed when there was a reduction in stent diameter of >50% or occlusion. Result(s): Of 164 patients treated, cumulative patency was 89% (median follow-up 2.4 yrs; range 46-308 wks). However, 70/164 (43%) patients required re-intervention to maintain patency (median number of re-interventions 2; range 1-6). The respective disease state of inflow vessels are shown in Table 1. Cumulative patency and re-intervention rates were significantly worse in patients with more than one diseased inflow vessel (P=0.47, P=0.004, respectively). Disease in the FV+PV+POPV was associated with a higher risk of re-intervention (16/25 (64%); HR 2.76; P=0.009, 95% CI [1.29, 5.92]), and was a strong predictor of cumulative patency loss compared with patients that had no inflow vessel disease (18/25 (72%) HR 17.26; P=0.009, 95% CI (2.02, 147.07). Conclusion(s): Maintaining stent patency in post-thrombotic limbs is influenced by the quality of inflow vessels. Patients with intraluminal scarring and/or residual thrombosis in the FV+PV+POPV should be counselled on their increased risk of patency loss.