Symptom Relief and Reintervention after Iliac Vein Stenting Stratified by CEAP Clinical Classification


      This study sought to evaluate long-term symptom relief and reintervention rates after iliac vein stenting (IVS) in patients with chronic venous outflow obstruction.


      A single-institution database of patients undergoing IVS from August 2011 to June 2021 was analyzed. Patients were stratified into three cohorts based on the clinical component of the clinical, etiology, anatomical, and pathophysiology (CEAP) classification: C3, C4, and C5/6. Symptoms were quantified using the venous clinical severity score (VCSS). Reintervention was defined as any procedure using venography. Edema, pigmentation, and ulceration progression-free survival as well as reintervention-free survival were assessed with Kaplan Meier analysis.


      Among 737 total patients, there were 435 C3, 206 C4, and 96 C5/6 patients. The C5/6 cohort had the highest percentage of patients undergo reoperation (36.4%). C5/6 patients yielded the poorest ulceration progression-free survival (P < 0.001) while C3 patients had the poorest skin pigmentation progression-free survival (P = 0.009). On adjusted analysis there was no significant difference in odds of reintervention between study cohorts. Mean composite VCSS scores were significantly different at each yearly post-operative follow-up visit up to 6 years.


      The present study is one of the largest investigations of long-term outcomes in IVS patients. Most patients with long-term follow-up experienced an improvement in their composite VCSS. CEAP clinical classification at the time of IVS had a significant influence on the likelihood and quantity of reintervention.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Eberhardt R.T.
        • Raffetto J.D.
        Chronic venous insufficiency.
        Circulation. 2014; 130: 333-346
        • Beebe-Dimmer J.L.
        • Pfeifer J.R.
        • Engle J.S.
        • et al.
        The epidemiology of chronic venous insufficiency and varicose veins.
        Ann Epidemiol. 2005; 15: 175-184
        • Rhodes J.M.
        • Gloviczki P.
        • Canton L.G.
        • et al.
        Factors affecting clinical outcome following endoscopic perforator vein ablation.
        Am J Surg. 1998; 176: 162-167
        • Phillips C.J.
        • Humphreys I.
        • Thayer D.
        • et al.
        Cost of managing patients with venous leg ulcers.
        Int Wound J. 2020; 17: 1074-1082
        • O'Donnell Jr., T.F.
        • Balk E.M.
        The need for an Intersociety Consensus Guideline for venous ulcer.
        J Vasc Surg. 2011; 54: 83s-90s
        • Lurie F.
        • Passman M.
        • Meisner M.
        • et al.
        The 2020 update of the CEAP classification system and reporting standards.
        J Vasc Surg Venous Lymphat Disord. 2020; 8: 342-352
        • Masuda E.
        • Ozsvath K.
        • Vossler J.
        • et al.
        The 2020 appropriate use criteria for chronic lower extremity venous disease of the American venous forum, the society for vascular Surgery, the American vein and lymphatic society, and the society of interventional Radiology.
        J Vasc Surg Venous Lymphat Disord. 2020; 8: 505-525.e504
        • Wen-da W.
        • Yu Z.
        • Yue-Xin C.
        Stenting for chronic obstructive venous disease: a current comprehensive meta-analysis and systematic review.
        Phlebology. 2016; 31: 376-389
        • Aboubakr A.
        • Chait J.
        • Lurie J.
        • et al.
        Secondary interventions after iliac vein stenting for chronic proximal venous outflow obstruction.
        J Vasc Surg Venous Lymphat Disord. 2019; 7: 670-676
        • Chait J.
        • Chapman E.K.
        • Subramaniam S.
        • et al.
        Persistent symptoms after endovenous thermal ablation may suggest proximal venous outflow obstruction.
        J Vasc Surg Venous Lymphat Disord. 2020; 8: 231-236
        • Lau I.
        • Png C.Y.M.
        • Eswarappa M.
        • et al.
        Defining the utility of anteroposterior venography in the diagnosis of venous iliofemoral obstruction.
        J Vasc Surg Venous Lymphat Disord. 2019; 7: 514-521.e514
        • Gagne P.J.
        • Tahara R.W.
        • Fastabend C.P.
        • et al.
        Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction.
        J Vasc Surg Venous Lymphat Disord. 2017; 5: 678-687
        • Razavi M.K.
        • Jaff M.R.
        • Miller L.E.
        Safety and effectiveness of stent placement for iliofemoral venous outflow obstruction: systematic review and meta-analysis.
        Circ Cardiovasc Interv. 2015; 8: e002772
        • Neglén P.
        • Hollis K.C.
        • Olivier J.
        • et al.
        Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result.
        J Vasc Surg. 2007; 46: 979-990