Endovascular therapy for iliac vein compression syndrome: superior outcomes in non-thrombotic patients and risk factors for stent restenosis.

OBJECTIVE

To evaluate the long-term efficacy and thrombotic outcomes of endovascular therapy for iliac vein compression syndrome (IVCS), with a focus on identifying risk factors for postoperative stent restenosis.

METHODS

This retrospective cohort study analyzed 98 IVCS patients treated with endovascular therapy at Hefei First People's Hospital between January 2020 and December 2022. Patients were divided into non-thrombotic (NIVCS, n=48) and acute thrombotic (TIVCS, n=50) groups. Outcomes included 1-year stent patency, complications, and quality-of-life metrics (CIVIQ-20 and VCSS scores). Logistic regression was used to identify risk factors for restenosis, with diagnostic performance accessed via ROC analysis.

RESULTS

The NIVCS group demonstrated significantly better 1-year stent patency (91.67% vs. 74%, P=0.018) but higher complication rates (20% vs. 8.33%, P=0.025) compared to the TIVCS group. Both groups showed significant improvements in CIVIQ-20 and VCSS scores (P<0.05), with NIVCS patients achieving better final outcomes. Multivariate analysis identified thrombotic IVCS (OR=3.41, 95% CI: 1.28-9.07), body mass index ≥28 kg/m (OR=2.89, 95% CI: 1.15-7.26), and hypertension (OR=2.54, 95% CI: 1.03-6.25) as independent predictors of restenosis. The predictive model demonstrated strong discriminative capacity (AUC=0.82, 95% CI: 0.74-0.90).

CONCLUSION

Endovascular therapy effectively improves symptoms and quality of life in IVCS, particularly in non-thrombotic cases. The thrombotic subtype, obesity, and hypertension significantly influence long-term stent patency, highlighting the need for personalized postoperative management. These findings underscore the potential of risk-stratified therapeutic strategies in vascular interventions.