By Katherine Kozlowski, Author and Contributor to Vein News and VeinsVeinsVeins.com
An increasing number of interventionalists are deploying venous stents for iliac vein obstruction related with iliac vein compression syndrome.
I am reviewing a study which has looked into stent patency rates for patients with iliac vein compression syndrome.
Who performed the study ?
The study was published by Lenize de Silva Rodrigues and colleagues from the Department of Surgery and Orthopedics, São Paulo State University - UNESP, Botucatu Medical School, Botucatu, SP, Brazil; Department of Surgery and Orthopedics, São Paulo State University - UNESP, Botucatu Medical School, Botucatu, SP, Brazil; Institute of Science and Technology, University Estadual Paulista, São Paulo, São José dos Campo, SP, Brazil; McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University, Hamilton, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.
What were the study methods ?
A systematic review and meta-analysis of published data in EMBASE, PubMed, Web of Science, Scopus, SciELO, and LILACS.
What are the study details ?
The study compared: unexposed patients with nonthrombotic iliac vein lesion (NIVL, group 1) vs exposed patients with iliac acute deep vein thrombosis (DVT, group 2); and NIVL (group 1) vs exposed patients with iliac vein obstruction and post-thrombotic syndrome (PTS, group 3).
What are the study results ?
Five studies with a total of 1050 participants and 1169 lower limbs were included.
Five hundred eighty-eight lower limbs presented NIVL (50.3%), 91 lower limbs presented acute DVT (7.7%), and 490 lower limbs presented PTS (42%).
The endovascular technical success rate of stenting did not differ in any of the groups: 99.6% in NIVL, 94.5% in acute DVT, and 96.5% in PTS (P = .0632).
The primary stent patency rates in the 6-month follow-up were 98.3% in NIVL vs 90.9% in PTS, with a statistical difference showing reduced stent patency rates in PTS (OR, 0.17; 95% CI, 0.06-0.48; P = .0008; I2 = 0%), and 100% in the NIVL group vs 91.6% in acute DVT, with no statistical difference (OR, 0.30; 95% CI, 0.06-2.32; P = .30; I2 = 0%).
The primary stent patency rates in the 12-month follow-up were 94.6% in NIVL vs 84.1% in PTS, with a statistical difference showing decreases stent patency rates in the PTS group (OR, 0.29; 95% CI, 0.14-0.63; P = .0008; I2 = 0%), and 91.1% in NIVL vs 90.9% in acute DVT, with no statistical difference (OR, 1.03; 95% CI, 0.26-4.07; P = .96; I2 = 0%).
What are the study conclusions ?
There is no statistical difference for the stent primary patency rates when the treatment is conducted in NIVL as compared with acute DVT lower limbs (at 6 and 12 months)
Because there were better results of stent primary patency rates for NIVL vs PTS patients, this finding favors the treatment of acute DVT instead of PTS in lower limbs, once PTS renders smaller stent patency rates at 6 and 12 months.
Reference: Rodrigues L de S, Berthanha M, El Dib R, Moura R. Association between deep vein thrombosis and stent patency in symptomatic iliac vein compression syndrome: Systematic review and meta-analysis. J vasc Surg venius Lymphat disord 2021; 9(1):275-284.