Outcomes of Iliac Venous Stenting in Patients with Combined Obstruction and Venous Reflux

Purpose: Iliac vein stenting alone has been shown to reduce symptoms in patients with combined outflow obstruction and venous reflux. Venous reflux is often only addressed when the patient reports symptom recurrence despite having adequately treated outflow obstruction with iliac vein stenting. This study investigates the incidence and time to patient-reported symptom recurrence in those who have undergone iliac vein stenting and the role that prompt evaluation and treatment of deep and superficial venous reflux may have in reducing symptom recurrence and re-intervention.

Materials and Methods: Single center, retrospective focusing on patients who underwent iliac vein stenting for compressive iliac lesions between 2017-2023. Data on initial clinical presentation, incidence and timing of symptom recurrence, need for repeat intervention, and availability of follow-up imaging was collected.


Results: Thirty patients underwent iliac vein stenting between 2017-2023 for symptomatic venous disease. Nine/30 (30%) presented with acute deep venous thrombosis (ADVT), 9/30 (30%) with chronic deep vein thrombosis (CDVT), and 12/30 (40%)  with non-thrombotic iliac vein lesions (NIVL). Recurrent symptoms were reported in 4/9 (44%) patients with ADVT, 4/9 (44%) patients with CDVT, and 10/12 (83%) patients with NIVL, with average onset at 15.5, 9.25, and 6.2 months post-procedure, respectively. Of the patients who reported recurrent symptoms, 2/4 (50%) with ADVT, ¾ (75%) patients with CDVT, and 4/10 (40%) with NIVL underwent evaluation with a dedicated ultrasound venous insufficiency study, which demonstrated the presence of reflux in 0/2 (0%), ⅔ (67%), and ¼ (25%) of patients with ADVT, CDVT, & NIVL, respectively.

Presenting condition	Total number of patients	Patients with recurrent symptoms (%)	Patients with recurrent symptoms who received a venous reflux study (%)	Patient who underwent repeat intervention (overall) (%)
ADVT	9	44	22	22
CDVT	9	44	33	33
NIVL	12	83	33	50

Conclusion: Although iliac vein stenting alone has been shown to significantly reduce symptoms in patients with combined outflow obstruction and venous reflux, this study demonstrates the high rate of symptom recurrence in patients where venous insufficiency is left untreated. Obtaining routine post-iliac vein stenting ultrasound for venous insufficiency evaluation may reveal a potentially under-treated population and present an area for practice improvement.