SIR Position Statement Outlines Appropriate Use of Endovascular Management for Treatment of Chronic Iliofemoral Venous Occlusions

July 5, 2023—The Society of Interventional Radiology (SIR) recently announced publication of a new position statement offering recommendations on the management of chronic iliofemoral venous obstruction with endovascular placement of metallic stents. Suresh Vedantham, MD, et al published the position statement online in Journal of Vascular and Interventional Radiology.

According to SIR, the statement indicates that among patients with chronic venous disease and iliofemoral venous obstruction, those who are experiencing life-disrupting symptoms or disability and who have anatomic features that favor long-term patency may be more likely to benefit from stenting as an adjunct to conservative management. Most other patients with chronic iliofemoral venous occlusions would be better served with conservative management alone, such as use of medical therapy and compression garments, and re-evaluated over time.

The society noted that the statement was composed by a multidisciplinary group of experts from interventional radiology, vascular medicine, and vascular surgery.

In the SIR press release, Dr. Vedantham commented, “There is strong consensus on the panel that excellent clinical decision-making around venous stent placement will be most likely when the treating physician has strong familiarity with key clinical considerations around optimal diagnosis and evaluation of iliac vein obstruction, as well as assessment of its clinical severity and life impact.”

He continued, “The statement provides a framework against which interventional radiologist physicians can review their practices, address knowledge gaps, deliver treatment effectively, and ensure that patients selected for stent placement are likely to benefit from it.” Dr. Vedantham is an interventional radiologist and professor with the Washington University in St. Louis in St. Louis, Missouri.

The statement authors advised that additional research is needed to better guide the use of stents in this patient population.

If completed, two ongoing multicenter randomized controlled trials—C-TRACT and BEST—can enable a strong and unbiased understanding of the treatment effects associated with the addition of venous stent placement to standard care, noted Dr. Vedantham.

“For both studies, success will depend on whether providers make it a priority to refer patients to study sites,” stated Dr. Vedantham. “It is hoped that physicians will promote the welfare of future venous disease patients by actively choosing now to enroll eligible patients in ongoing clinical trials that are designed to generate high-quality evidence on the benefits, risks, and best practices around venous stent placement.”

SIR stated that while this research proceeds, adherence to the statement’s recommendations will enable judicious use of endovascular therapy in a manner that optimizes benefit and minimizes harm.

SIR President Alda L. Tam, MD, commented in the society’s press release, “The new statement provides the best assessment of the current evidence we have to date, and SIR is grateful to the authors for their time and energy in ensuring that we have evidence-based guidance for the treatment of chronic venous occlusions. SIR remains committed to supporting ongoing and future research in this area to ensure that physicians have the information they need to optimize patient care now and in the future.”

The society noted that the new statement on the treatment of chronic iliofemoral venous occlusions is a companion to the SIR statement on the treatment of acute iliofemoral deep vein thrombosis, which was announced in November 2022, and published by Dr. Vedantham et al in Journal of Vascular and Interventional Radiology (2023;34:284-299).