Endovascular stenting for chronic femoro-iliac venous obstructive disease: Clinical efficacy and short-term outcomes - 27/04/19

Doi : 10.1016/j.diii.2019.03.014

K. Guillen ^a, N. Falvo ^b, M. Nakai ^a, O. Chevallier ^a, S. Aho-Glélé ^c, C. Galland ^a, E. Demaistre ^d, L. Pescatori ^a, M. Samson ^e, S. Audia ^e, B. Bonnotte ^e, M. Midulla ^a, R. Loffroy ^a,^⁎
^a Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, Hôpital Universitaire François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
^b Department of Angiology and Vascular Medicine, Hôpital Universitaire François-Mitterrand, 21079 Dijon, France
^c Department of Epidemiology, Statistics and Clinical Research, Hôpital Universitaire François-Mitterrand, 21079 Dijon, France
^d Department of Biological Hemostasis and Thrombosis Treatment, Hôpital Universitaire François-Mitterrand, 21079 Dijon, France
^e Department of Internal Medicine and Clinical Immunology, Hôpital Universitaire François-Mitterrand, 21079 Dijon, France

^⁎Corresponding author.

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Abstract

Purpose

To report the clinical efficacy and mid-term outcomes of endovascular treatment in patients with chronic, symptomatic, post-thrombotic femoro-iliac venous obstruction.

Materials and methods

Forty-two patients with post-thrombotic syndrome (PTS) presenting with femoro-iliac venous obstructive lesions treated in our institution by endovascular approach between March 2012 and October 2017 were retrospectively included. There were 27 women and 15 men with a mean age of 47.3±17 (SD) years (range: 22–86 years). Procedure included first venous recanalization, then pre-dilatation and self-expandable metallic stenting of the narrowed or occluded iliac and/or femoral veins. Severity of PTS and quality of life were assessed at baseline and 3 months after the intervention respectively, using Villalta score and Chronic Venous Insufficiency Questionnaire (CIVIQ-20) scale. Imaging follow-up evaluation of stent patency was based on the results of duplex Doppler ultrasound and computed tomography.

Results

Immediate technical success was achieved in 41/42 (97.6%) patients, without any major complications. Primary patency, primary assisted patency and secondary patency at the end of the median imaging follow-up of 18.1 months (IQR, 9.7–34.4) were achieved in 29/42 (66.7%) patients, 33/42 (78.6%) patients and 37/42 (88.1%) patients, respectively. Median Villalta and CIVIQ-20 scores decreased from 14 (IQR, 10–19) and 57 (IQR, 39–72) at baseline, respectively, to 5 (IQR, 2–9) and 30 (IQR, 24–50) 3 months after the procedure, respectively (P<0.0001), showing significant decrease in the severity of PTS and improvement in the quality of life. The multiple linear regression model showed that both baseline Villalta and CIVIQ-20 scores ([95% CI: −7.80–3.79; P<0.0001] and [95% CI: 0.07–0.20; P<0.0001], respectively), age (95% CI: 0.04–0.19; P=0.002) and stenting expanse (95% CI: 0.97–5.65; P=0.006) were independent variables related to Villalta gain. Baseline Villalta (95% CI: 0.89–2.23; P<0.0001) was the single independent variable related to CIVIQ-20 gain.

Conclusion

This study confirms the high clinical efficacy and favorable mid-term outcomes of endovascular stenting in patients with chronic symptomatic femoro-iliac venous obstructive lesions.

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Keywords : Post-thrombotic syndrome, Endovascular treatment, Self expandable metallic stents, Quality of life, Iliac vein