Published online Dec 28, 2021. doi: 10.4329/wjr.v13.i12.371
Peer-review started: February 10, 2021
First decision: October 17, 2021
Revised: November 25, 2021
Accepted: December 9, 2021
Article in press: December 9, 2021
Published online: December 28, 2021
The long-term management following venous stenting in thrombotic iliac vein compression syndrome is complex and patient specific. Because there was no significant difference in stent patency or re-intervention rates amongst thrombophilia positive and negative patients, the need for thrombophilia testing should be individualized and only considered when it will impact post-procedural medical management. Future studies focusing on anticoagulation related to venous stenting in larger cohorts would be helpful.
Half of patients with stented thrombotic iliac vein compression syndrome and thrombophilia testing were positive. The presence of thrombophilia did not demonstrate a significant difference in stent patency or re-intervention rates.
65 patients underwent successful balloon angioplasty and common iliac vein (CIV) stenting. Stent patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo (92.3% vs 81.3%, P = 0.6), 6 mo (83.3% vs 80%, P > 0.9), or 12 mo (77.8% vs 76.9%, P = 0.8). Immediately after stent placement, thrombophilia patients were more likely to be placed on dual therapy (aspirin and anticoagulation) or triple therapy (aspirin, clopidogrel, and anticoagulation) (50% vs 41.2%, P > 0.9), and remain on dual therapy at 6 mo (25% vs 12.5%, P = 0.5) and 12 mo (25% vs 6.7%, P = 0.6). There was no significant difference in re-intervention rates (25% vs 35.3%, P = 0.7) or number of re-interventions (average 2.3 vs 1.3 per patient, P = 0.4) between thrombophilia positive and negative patients.
A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent CIV stenting at a large academic center. Non-thrombotic lesions and iliocaval thrombosis and/or occlusions were excluded. Demographic information, procedural data points, and post-procedural management were compared between thrombophilia positive and negative patients.
To evaluate the prevalence and compare how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression syndromes.
Guidelines for therapeutic anticoagulation after iliocaval stent placement remain variable by institution, however long-term anticoagulation is often recommended in patients with underlying thrombophilia. Whether or not the presence of an underlying thrombophilia increases the risk of recurrent thrombosis, particularly in-stent thrombosis in patients that have undergone venous interventional procedures, remains unknown.
Iliofemoral vein thrombosis accounts for approximately 25% of all deep vein thrombosis and is associated with an increased risk of embolic and post-thrombotic complications. Anticoagulation is the standard of care for the treatment of symptomatic acute deep vein thrombosis. However, despite appropriate anticoagulant therapy, the post-thrombotic syndrome remains a frequent complication seen in 30% to 50% of patients diagnosed with iliofemoral deep vein thrombosis. To reduce the burden of post-thrombotic symptoms, endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease.