The role of inflow disease on patency of venous stents for post-thrombotic syndrome

Jay M Bakas; Mark A F de Wolf; Renate R van den Bos; Wendy S J Malskat; Catherine van Montfrans; Gwendolyn M van der Wilden; Hence J M Verhagen; Marie Josee E van Rijn

doi:10.1016/j.jvir.2024.11.030

The role of inflow disease on patency of venous stents for post-thrombotic syndrome

J Vasc Interv Radiol. 2024 Dec 9:S1051-0443(24)00754-1. doi: 10.1016/j.jvir.2024.11.030. Online ahead of print.

Authors

Jay M Bakas¹, Mark A F de Wolf², Renate R van den Bos³, Wendy S J Malskat³, Catherine van Montfrans³, Gwendolyn M van der Wilden⁴, Hence J M Verhagen⁴, Marie Josee E van Rijn⁴

Affiliations

¹ Department of Surgery, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: j.bakas@erasmusmc.nl.
² Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
³ Department of Dermatology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
⁴ Department of Surgery, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.

PMID: 39662620
DOI: 10.1016/j.jvir.2024.11.030

Abstract

Purpose: This study aimed to identify the risk of deep femoral vein (DFV) and/or femoral vein (FV) inflow disease on venous stent patency loss in post-thrombotic syndrome.

Methods: This single-center retrospective study included limbs with iliofemoral and ilocaval stents for PTS. Single-vessel and double-vessel inflow disease was defined based on imaging of possible post-thrombotic changes in the DFV/FV. Endpoints were 1-year primary (open stents without re-intervention), and secondary patency (open stents with or without re-intervention). Event-free survival was estimated using Kaplan-Meier methods (Log-rank test). Univariate and multivariate binary logistic regression were conducted to estimate the effects of various covariates on the risk of primary patency loss.

Results: Eighty limbs were included: 37 limbs (46%) without inflow disease, 26 limbs (33%) with single-vessel, and 17 limbs (21%) with double-vessel inflow disease. One-year primary patency was higher for limbs without inflow disease (89.2%), compared with single-vessel (57.7%, p=.002), and double-vessel inflow disease (47.1%, p<.001). No significant differences were found for secondary patency. Inflow disease predicted 1-year primary patency loss: OR 7.17 [95%CI: 2.16-23.78], p=.001 (univariate). Inflow disease of the FV was the only significant predictor after multivariate analysis: OR 10.99 [95%CI: 2.59-46.74], p=.001.

Conclusion: Inflow disease increases the risk of patency loss within the first year after treatment with venous stents for PTS. Inflow should be discussed with patients to improve decision-making and expectations.

Keywords: Inflow; Post-thrombotic Syndrome; Regional Blood Flow; Stents; Vascular Patency.