RS29 - Iliac Vein Stenting Outcomes for Patients with Superficial Venous Insufficiency Concurrent with Deep Venous Disease

Objectives: Superficial venous insufficiency (SVI) and chronic proximal venous outflow obstruction (PVOO) can occur in the same patient before, during, or after iliac vein stenting while some patients with PVOO never develop SVI. The clinical course of these different patients remains unclear. We undertook this study to determine how SVI would influence the outcomes after vein stenting for chronic PVOO.

Methods: A retrospective registry of 546 patients who underwent iliac vein stent placement for chronic PVOO at a single institution from 2011-2021 was analyzed. Three groups of patients were followed for up to six years after initial vein stent placement: Group 1 (G1; n=178, 32.2%) had no SVI before or after stent placement, Group 2 (G2; n=64, 11.6%) had SVI before stent placement, and Group 3 (G3; n=311, 56.2%) presented with SVI before and after stent placement. Patient symptoms were evaluated using venous clinical severity score (VCSS) and CEAP class. Reinterventions after initial stent placement were recorded. Major reoperations were defined as any subsequent iliac re-interventions that included venogram. Minor reoperations were defined as endovenous thermal ablation. Multivariate regression models were used to determine odds of major or minor reintervention.

Results: Across the three groups, mean age (G1: 65.3 vs. G2: 60.2 vs G3: 59.8; p< 0.001), diabetes (32.6% vs. 25.0% vs. 16.1%; p< 0.001), and hypertension (68.5% vs. 39.1% vs. 42.8%; p< 0.001) differed significantly (Table I). Smoking status (p=0.32) and history of DVT (p=0.135) were similar. The preoperative composite VCSS score differed across the three groups (8.7 vs. 11.3 vs. 11.1; p< 0.001). Postoperatively until year 6, all groups showed improvement in VCSS composite scores. Group 2 showed the greatest improvement in VCSS composite score 30-days postoperatively (3.4 vs. 6.3 vs. 3.3; p< 0.001). Days of follow-up were similar across the three groups (p=0.735). After multivariable adjustment, Groups 2 and 3 were significantly more likely (G2vG1: OR=3.10, 95% CI=1.22, 8.05, p=0.018; G3vG1: OR=6.27, 95%CI=3.17, 13.24, p< 0.001) than Group 1 to receive a minor, but not a major reintervention (Table II), and both groups had reoperations sooner than Group 1 (525.7 days vs. 353.6 days vs. 244.4 days; p< 0.001).

Conclusions: Compared to patients without SVI, patients with SVI concurrent with PVOO showed greater long-term improvement in VCSS composite scores and were more likely to receive a minor reintervention following iliac vein stenting. If reintervention was required, patients with concurrent SVI required reintervention sooner than those without concurrent SVI.