Long-term outcomes of stent placement for symptomatic nonthrombotic iliac vein compression lesions in chronic venous disease

Purpose: To assess the clinical and patency results of stent placement for the management of symptomatic nonthrombotic iliac vein compression lesions (NIVCLs) in chronic venous disease (CVD).

Materials and methods: A retrospective analysis of patients with CVD was conducted at a single institution from January 2000 to May 2010. In 2,093 patients with CVD, venous computed tomography (CT) angiography or transfemoral venography was selectively performed in patients with severe symptoms and in patients with symptom recurrence after endovenous laser ablation (EVLA) for superficial venous insufficiency in the left lower extremity. NIVCLs were found in 297 patients (41 NIVCLs were found in 74 patients whose symptoms recurred after EVLA for superficial venous insufficiency). In 205 patients, NIVCLs were successfully treated with stent placement. Among these 205 patients, 117 patients (132 limbs) with associated superficial reflux were treated by EVLA for superficial venous insufficiency. Quality of life and the severity of venous disorders were evaluated by questionnaire and clinical examination before and after treatment. Patency was evaluated by duplex Doppler ultrasound.

Results: A total of 227 stents were placed in 205 patients (224 limbs; median age, 50.53 years). The rate of technical success was 100%. Three limbs were treated with two stents because of proximal migration of the incipient stent. Follow-up periods ranged from 1-117 months (mean 50 months ± 36). The primary and assisted-primary cumulative patency rates at a mean of 4 years were 98.7% and 100%. The cumulative edema relief rate was 89.1% (156 of 175), and the healing rate for active ulcers was 82.3% (51 of 62). The pain level (using a visual analogue scale from 0-10) declined from a median level of 4.3 before the procedure to 0.4 after the procedure. Quality of life improved significantly after intervention. Complications were minor and improved quickly.

Conclusions: Venous stent placement is an effective and durable treatment for NIVCL, with long-term high patency and results in significant relief of the major symptoms of CVD. NIVCL is an important reason for symptom recurrence after left lower extremity varicose vein surgery.