ESAL: A Tool for the Explanatory Prediction of Loss of Patency Within 1 Year After Iliac Vein Stent Placement.

Abstract

Objective: Establish a predictive tool for assessing post-iliac vein stent placement (IVSP) patency loss within 1 year.

Background: Post-IVSP stent surveillance is vital for detecting stent malfunction and guiding interventions. Despite extensive research on vascular patency after IVSP, individual risks for patency loss remain understudied.

Materials and methods: We developed a predictive model for assessing patency loss risk within 1 year after IVSP using data from 162 patients. Cox regression and the Boruta method identified risk factors, leading to the construction of a random forest (RF) model. We validated the model's performance using testing data and developed a user-friendly risk tool, the Etiology-Stenosis-Age-Length (ESAL) Classification.

Results: The RF model demonstrated excellent performance, with high sensitivity, specificity, and negative predictive value. Risk factors identified included younger age, post-thrombotic lesions, short-segment occlusions, and preoperative target lesion occlusion. Shapley Additive exPlanations analysis and Cox regression enhanced model interpretability.

Conclusions: We present a novel, intuitive model for assessing patency loss risk after IVSP. The ESAL classification provides clinicians with a practical tool to identify high-risk patients. Future research should focus on larger, more representative cohorts to validate and refine the model.Clinical ImpactHow will this change clinical practice?The risk of iliac vein stent patency loss within one year post-placement can be predicted in advance.What does it mean for the clinicians?The newly introduced Etiology-Stenosis-Age-Length (ESAL) Classification offers clinicians a practical and user-friendly tool for identifying high-risk patients who may experience patency loss after iliac vein stent placement.What is the innovation behind the study?Researchers have successfully developed a predictive model for assessing the risk of iliac vein stent patency loss within one year post-placement.