Clinical tolerance of untreated reflux after iliac vein stent placement.

BACKGROUND: We have recently demonstrated in a large patient cohort that the prevalence and severity of reflux improves in most limbs post-stenting while the majority of limbs do not develop new onset of reflux. In this particular report, we focus on the long term clinical outcomes associated with untreated reflux in the same patient cohort who underwent iliofemoral venous stenting without correction of residual reflux.

PATIENTS AND METHODS: Clinical outcomes data from 1379 limbs who underwent only iliac vein stenting without the correction of superficial or deep reflux from 1997 to 2018 was analyzed (23-year follow-up period): 632 (46%) limbs had pre-existing reflux prior to stenting while 747 (54%) limbs did not. Reflux data for these patients (reflux segmental score, air plethysmography and ambulatory venous pressure) has been reported in detail in a prior publication. The subsets were compared perioperatively with each other in terms of the following variables: grade of swelling (GOS), visual analogue pain score (VAS), Venous Clinical Severity Score (VCSS), venous stasis dermatitis, ulceration and quality of life (QoL) measures.

RESULTS: Both groups demonstrated improvements in VCSS, GOS, VAS and QOL. There was no difference in ulcer healing (5% versus 3% for limbs with and without prestent reflux respectively) and resolution of dermatitis (6% versus 5% for limbs with and without prestent reflux respectively) between the two groups. Among limbs with pre-existing reflux (n=632), 218 (34%) had axial reflux while the remainder had non-axial reflux (n=414, 66%). Clinical outcomes were similar between the two groups. Based on multi-segment reflux score, limbs with pre-stent reflux (n=632) were divided into two groups. Segmental score ≥ 3 indicated severe reflux while a score of less than 3 indicated moderate reflux. 161 (25%) limbs had severe reflux while the remainder of the limbs (471, 75%) had moderate reflux. The two groups demonstrated similar outcomes for most clinical parameters. Similarly, post-thrombotic limbs and non-thrombotic limbs showed similar outcomes.

CONCLUSION: Long term follow-up of patients after iliac vein stenting shows that uncorrected reflux is well tolerated in most patients across the majority of clinical measures.