Low Post-Stent Placement Iliofemoral Vein Peak Velocity by Doppler Ultrasound: Prognostic Implication for Re-Intervention in Thrombotic Iliac Vein Lesions.

Abstract

Purpose: To investigate the association between post-stent placement peak velocity in the iliofemoral vein and re-intervention in patients with thrombotic iliac vein lesions.

Methods: This was a single-center retrospective cohort study. Between January 2014 and February 2024, consecutive patients who received primary stent placement for thrombotic iliac vein lesions with eligible post-procedure duplex ultrasound were included. Twenty random limbs with normal duplex ultrasound findings were selected to investigate the venous peak velocities in normal limbs. Cox regression models were used to determine predictive factors for re-intervention with a hazard ratio (HR).

Results: Fifty-one patients (54 limbs) were included. The mean age was 41.9 ± 18.2 years, and 78.4% were female. During a median follow-up of 32.7 months, 27.7% (15/54) of limbs encountered symptom recurrence with stent malfunction and received re-intervention. There was no significant difference in CIV peak velocity between patent stented limbs and normal limbs (30.3 vs 32.0 cm/s, p = .29). However, the limbs that required re-intervention had a significantly lower CIV peak velocity (25.3 vs 32.0 cm/s, p < .001). Post-stent placement peak velocities in the iliofemoral veins were significantly associated with re-intervention. ROC analysis suggested common iliac vein (CIV) peak velocity had the highest predictive performance (area under curve = 0.76). A CIV peak velocity < 26.6 cm/s (adjusted HR 6.66; p = .016) was significantly associated with an increased re-intervention risk.

Conclusion: Low post-stent placement peak velocities in the iliofemoral veins were significantly associated with future re-intervention in patients with thrombotic iliac vein lesions.

Level of evidence: Level 4, Case Series.