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Endovascular therapy yields high patency rates in patients with iliac vein compression syndrome
Patients who underwent endovascular therapy for treatment of iliac vein compression syndrome had high rates of primary and secondary midterm patency, with no severe complications related to the procedure, according to results of a retrospective analysis.
Researchers evaluated follow-up data from 233 symptomatic patients with iliac vein compression syndrome (IVCS) who underwent endovascular therapy at a single facility. Sixty-six patients had no evidence of deep vein thrombosis, 110 also had ipsilateral acute DVT, and 57 also had subacute thrombosis or chronic obstruction in the iliac and common femoral veins.
After treatment, patients received anticoagulation therapy, including low–molecular-weight heparin followed by daily warfarin for at least 6 months. All patients also received a recommendation to wear elastic stockings for at least 1 year. Follow-up occurred at 3, 6 and 12 months after the procedure, and then annually (median duration, 34 months).
Treatment was successful in 96.6% of cases. All patients who underwent successful therapy were treated with percutaneous transluminal angioplasty and stents. Cumulative primary patency rates were 93.2% at 1 year, 84.3% at 3 years and 74.5% at 5 years. Secondary patency rates were 100%, 93.3% and 92% at 1, 3 and 5 years, respectively.
No patients experienced severe complications related to treatment. The most frequently reported adverse event was transitory pain in the left lower back, which occurred in 162 patients; however, the researchers noted that the pain resolved without need for further intervention in all cases. Subcutaneous ecchymosis occurred in 11 patients, and seven patients experienced transitory epistaxis during follow-up. Severe upper gastric bleeding occurred in two cases, both of which were successfully treated. Thirty patients were unable to adhere to the elastic stocking recommendation.
Factors found to be independently predictive of in-stent obstruction on multivariate analysis included implantation of multiple stents (HR = 4.033; 95% CI, 2.493-6.524) and nonadherence to the elastic stocking recommendation (HR = 2.586; 95% CI, 1.183-5.653).
The researchers wrote that their findings “[suggest] that endovascular treatment for IVCS is safe and effective, regardless of the existence of [deep vein thrombosis]. This treatment can re-establish unimpeded flow through the iliac veins to the inferior vena cava and relieve symptoms in the majority of treated patients.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.