Stent Placement for Iliofemoral Venous Outflow Obstruction Evaluated in Meta-Analysis

October 21, 2015—Mahmood K. Razavi, MD, Michael R. Jaff, DO, and Larry E. Miller, PhD, conducted a systematic review and meta-analysis to evaluate the safety and effectiveness of stent placement for iliofemoral venous outflow obstruction. The investigators published their findings online ahead of print in Circulation: Cardiovascular Interventions.

According to the investigators, endovenous recanalization of iliofemoral stenosis or occlusion with angioplasty and stent placement has been increasingly used to maintain long-term venous patency in patients with iliofemoral venous outflow obstruction. The purpose of this systematic review and meta-analysis was to determine safety and effectiveness of venous stent placement in patients with iliofemoral venous outflow obstruction.

As summarized in Circulation: Cardiovascular Interventions, the investigators searched the MEDLINE and EMBASE databases for studies evaluating the safety or effectiveness of stent placement in patients with iliofemoral venous outflow obstruction. Data were extracted by disease pathogenesis: nonthrombotic, acute thrombotic, or chronic postthrombotic. Main outcomes included technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years. 

A total of 37 studies reporting 45 treatment effects (nonthrombotic, 8; acute thrombotic, 19; and chronic postthrombotic, 18) from 2,869 patients (nonthrombotic, 1,122; acute thrombotic, 629; and chronic postthrombotic, 1,118) were included. 

The investigators reported that technical success rates were comparable among groups, ranging from 94% to 96%. Complication rates among groups ranged from 0.3% to 1.1% for major bleeding, from 0.2% to 0.9% for pulmonary embolism, from 0.1% to 0.7% for periprocedural mortality, and from 1% to 6.8% for early thrombosis. Patient symptom relief data were reported inconsistently. At 1 year, primary and secondary patency were 96% and 99% for nonthrombotic, 87% and 89% for acute thrombotic, and 79% and 94% for chronic postthrombotic patients

The investigators concluded that stent placement for iliofemoral venous outflow obstruction results in high technical success and acceptable complication rates regardless of the cause of obstruction.