Prognostic Value of a Classification System for Iliofemoral Stenting in Patients with Chronic Venous Obstruction

Houman Jalaie; Mohammad E Barbati; Long Piao; Suat Doganci; Nils Kucher; Mert Dumantepe; Olivier Hartung; Michael Lichtenberg; Stephen Black; Gerard O'Sullivan; Efthymios D Avgerinos; Alun H Davies; Mahmood K Razavi; International CVO Classification Study Group

doi:10.1016/j.ejvs.2024.10.002

Prognostic Value of a Classification System for Iliofemoral Stenting in Patients with Chronic Venous Obstruction

Eur J Vasc Endovasc Surg. 2024 Oct 10:S1078-5884(24)00873-6. doi: 10.1016/j.ejvs.2024.10.002. Online ahead of print.

Collaborators

International CVO Classification Study Group:
Irwin M Toonder¹⁴, Tim Sebastian⁵, Christian Erbel¹⁵, Majid Moini¹⁶, Rick de Graaf¹⁷, Rachael I Morris⁹, Eoin O'Malley¹⁰, Rabih A Chaer¹⁸

Affiliations

¹ Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany.
² Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany. Electronic address: [email protected].
³ Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany; Department of Vascular and Endovascular Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China.
⁴ Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey.
⁵ Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
⁶ Department of Cardiovascular Surgery, Uskudar University School of Medicine, Istanbul, Turkey.
⁷ Department of Vascular Surgery, Nord University Hospital of Marseille, Marseille, France.
⁸ Department Angiology, Klinikum Hochsauerland, Arnsberg, Germany.
⁹ Academic Department of Vascular Surgery, Cardiovascular Division, St Thomas' Hospital, King's College London, London, UK.
¹⁰ University Hospital Galway, Newcastle Road, Galway, Ireland.
¹¹ Division of Vascular Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.
¹² Section of Vascular Surgery, Imperial College, London, UK.
¹³ St Joseph Heart & Vascular Centre, Orange, CA, USA.
¹⁴ Foundation Grave Centre of Phlebology, Grave, The Netherlands.
¹⁵ Department of Cardiology, Angiology, Pneumology, University Hospital Heidelberg, Heidelberg, Germany.
¹⁶ Vascular Surgery Department, Sina Hospital, Tehran, Iran.
¹⁷ Department of Diagnostic and Interventional Radiology, Clinic of Friedrichshafen, Friedrichshafen, Germany.
¹⁸ Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

PMID: 39393577
DOI: 10.1016/j.ejvs.2024.10.002

Abstract

Objective: This retrospective, multicentre study aimed to assess the prognostic value of a proposed classification system for chronic venous obstruction (CVO) patients undergoing successful interventional procedures.

Methods: This study analysed data from 13 vascular centres, including 1 033 patients with CVO treated between 2015 - 2019. The patients were classified into five category types: 1 - non-thrombotic iliac vein lesion; 2 - CVO of iliac segment; 3 - CVO of iliofemoral segment above common femoral vein confluence; 4 - CVO of iliofemoral segment extending into the femoral vein (FV) or deep femoral vein (DFV); and 5 - CVO of iliofemoral segment involving both DFV and FV. Stent deployment, complications, and follow ups were evaluated. Uni- and multivariable analyses were performed to identify predictors of primary patency loss.

Results: The mean age of the patients was 44.0 ± 14.7 years, with 59.9% being women. A median of two stents was used for unilateral cases and five stents for bilateral cases. At twelve months follow up, primary patency rates for types 1 - 5 were 94.9%, 90.3%, 80.8%, 60.6%, and 39.4%, respectively. These rates were strongly correlated with the extent of CVO and showed significant differences between each type. Univariable analysis identified predictors of primary patency loss as the type of CVO, history of deep vein thrombosis, and the total number of stents. In the multivariable analysis, the significant independent predictors of primary patency loss were the type of CVO and the total number of stents.

Conclusion: The proposed anatomical classification of iliofemoral CVO will help to predict intervention outcomes and facilitate comparison of stent outcomes in future studies. However, further evaluation and validation in prospective studies are needed to confirm the utility of this classification.

Keywords: Anatomical classification; Chronic venous obstruction; Iliofemoral venous obstruction; Interventional procedures; Prognostic value; Venous stents.