Outcomes following stenting for symptomatic chronic iliofemoral venous stenosis - A comparison of three stent types.

Abstract

Objective: Venous stenting has become the standard of care for patients with iliofemoral venous stenosis who have failed conservative therapy. While outcome data following such stenting exist for Wallstents and Wallstent - Z stent combination, such data for dedicated stents is sparse outside of industry-sponsored trials. This study aims to address this gap by comparing the outcomes of matched cohorts of limbs that underwent stenting with either the Medtronic Abre stent (Medtronic Inc, Minneapolis, MN), the Bard Venovo stent (Becton, Dickinson, and Co, Franklin Lakes, NJ), or Wallstent-Zenith (Z) stent combination (Boston Scientific, Marlborough, MA; Cook Medical Inc, Bloomington, IN).

Methods: Contemporaneously entered data on matched cohorts of patients who underwent stenting from 2016 to 2022 for quality of life (QOL)-impairing iliofemoral venous stenosis (not occlusion) after failing conservative therapy was analyzed. The venous clinical severity score (VCSS: 0-27), grade of swelling (GOS: 0-4), visual analog scale pain score (VAS pain score: 0-10), and CIVIQ-20 quality of life (QOL) score were evaluated initially and post stenting to assess the effects of stenting. ANOVA and paired t-tests were used to compare clinical and QOL variables, while Kaplan-Meier analysis was used to examine primary, primary-assisted, and secondary stent patencies with log-rank test used to discriminate between different curves.

Results: There was a total of 198 limbs that had undergone stenting including 68 in the Abre, 60 in the Venovo and 70 in the Wallstent - Z stent groups. The median age for the entire cohort was 65 years (range 21-101 years). The cohort included 141 women and 57 men. Left laterality (112 limbs) was more common than right laterality (86 limbs). Post-thrombotic syndrome was seen in 146 limbs and nonthrombotic iliac vein lesions/May-Thurner syndrome in 52 limbs. The median BMI was 35. Median follow up was 20 months. For the entire cohort, post stenting, VCSS improved from 6 to 4.5 at 3 months (p<0.0001) further improved to 4 at 6 months (p<0.0001) and remained at 4 at 12 months (p<0.0001), and 24 months (p<0.0001). GOS for the entire cohort improved from 3 to 1 at 3 months (p<0.0001) and remained at 1 at 6 months, (p<0.0001), 12 months (p<0.0001), and 24 months (p<0.0001). VAS pain score for the entire cohort improved from 8 to 2 at 3 months (p<0.0001), increased to 3 at 6 months (p<0.0001) before dropping to 2 at 12 months (p<0.0001), and remained at 2 at 24 months (p<0.0001). The CIVIQ-20 score for the entire cohort improved from 61 to 38 (p<0.0001) over the duration of follow up. The primary patencies for the Abre, Bard, and Wallstent-Z stent groups at 32 months were 93%, 86%, and 92%, respectively (p=0.37). Primary assisted patencies for all 3 groups at 32 months was 100% (p=0.08). There were no stent occlusions in any of the groups. Reintervention was pursued for QOL impairing recurrent clinical manifestations in 13 limbs (7%), without a significant difference between groups (p=0.46).

Conclusions: For patients undergoing stenting for quality-of-life impairing symptoms of iliofemoral venous stenosis after failing conservative therapy, Abre, Venovo and Wallstent-Z stent combination all appear to provide similar clinical and quality of life improvement. A significant difference between stent patencies for the three stent types was also not detected. Stent selection for treatment of stenotic lesions of the iliofemoral venous territory can be based on stent availability and the preference/expertise of the interventionalist.