Endovascular therapy for iliac vein compression syndrome: superior outcomes in non-thrombotic patients and risk factors for stent restenosis.

Objective: To evaluate the long-term efficacy and thrombotic outcomes of endovascular therapy for iliac vein compression syndrome (IVCS), with a focus on identifying risk factors for postoperative stent restenosis.

Methods: This retrospective cohort study analyzed 98 IVCS patients treated with endovascular therapy at Hefei First People's Hospital between January 2020 and December 2022. Patients were divided into non-thrombotic (NIVCS, n=48) and acute thrombotic (TIVCS, n=50) groups. Outcomes included 1-year stent patency, complications, and quality-of-life metrics (CIVIQ-20 and VCSS scores). Logistic regression was used to identify risk factors for restenosis, with diagnostic performance accessed via ROC analysis.

Results: The NIVCS group demonstrated significantly better 1-year stent patency (91.67% vs. 74%, P=0.018) but higher complication rates (20% vs. 8.33%, P=0.025) compared to the TIVCS group. Both groups showed significant improvements in CIVIQ-20 and VCSS scores (P<0.05), with NIVCS patients achieving better final outcomes. Multivariate analysis identified thrombotic IVCS (OR=3.41, 95% CI: 1.28-9.07), body mass index ≥28 kg/m² (OR=2.89, 95% CI: 1.15-7.26), and hypertension (OR=2.54, 95% CI: 1.03-6.25) as independent predictors of restenosis. The predictive model demonstrated strong discriminative capacity (AUC=0.82, 95% CI: 0.74-0.90).

Conclusion: Endovascular therapy effectively improves symptoms and quality of life in IVCS, particularly in non-thrombotic cases. The thrombotic subtype, obesity, and hypertension significantly influence long-term stent patency, highlighting the need for personalized postoperative management. These findings underscore the potential of risk-stratified therapeutic strategies in vascular interventions.