Efficacy of balloon venoplasty alone in the correction of nonthrombotic iliac vein lesions.

Objective: Iliac vein stenting of nonthrombotic iliac vein lesions is an evolving treatment course for management of chronic venous insufficiency. To characterize these lesions, we examined our experience treating these lesions with balloon venoplasty before stenting.

Methods: A retrospective analysis was performed to study all patients who underwent venograms with venoplasty and stenting of iliac veins from February 2013 to July 2016. All patients included in the study were treated with a trial conservative management for 3 consecutive months before venogram and, if indicated, venoplasty was performed. If a greater than 50% reduction in cross-sectional area or diameter was observed on intravascular ultrasound examination, the stenotic area was treated with balloon angioplasty, sized to nonstenotic distal vein segment (range, 10 × 40 mm to 16 × 60 mm). Intravascular ultrasound examination was also used to measure the area of stenotic iliofemoral veins before and after balloon angioplasty.

Results: A total of 1021 venograms with venoplasty and stenting of iliac veins were performed in 713 patients from February 2013 to July 2016. The mean age of the study population age was 64.88 years (range, 21-99 years; standard deviation [SD], 14.57), with 451 female and 262 male patients. Before angioplasty, the mean cross-sectional stenotic area was 67.97 mm (range, 6-318 mm; SD, 34.87). After balloon angioplasty, the mean stenotic area increased to 78.80 (range, 6-334 mm; SD, 44.50; P < .001). The targeted stenotic areas were categorized into three categories: group A, increased (>10% of baseline before venoplasty); group B, decreased (<10% of baseline), and group C, no area change (±10% of baseline). In 500 limbs (48.9%), the stenotic areas improved after venoplasty (average 36.99%), with a prevenoplasty average area of 60.81 mm (SD, 32.80 mm) and a postvenoplasty average of 96.52 mm (SD, 49.85 mm). In 294 limbs (28.8%), the area decreased (average 28.90%), with a prevenoplasty average area of 76.43 mm (SD, 38.80 mm) and a postvenoplasty average of 53.22 mm (SD, 26.61 mm). There were 227 patients (22.2%) who had the same area before and after venoplasty. Left-sided lesions had a greater increase in area than right-sided lesions (51.3% vs 46.2%, respectively; P = .048). No significant correlation of stenotic area response with age, presenting symptoms of Clinical, Etiology, Anatomy, and Pathophysiology (C2-C6), gender, or location of targeted lesion was observed.

Conclusions: Our data show there is a highly variable response after venoplasty of stenotic area of nonthrombotic iliac vein lesions. Balloon venoplasty showed greater improvement in improving the area of stenotic left-sided lesions. However, stenting of the lesions should be performed routinely owing to recoil and spasm in lesions.