Effect of venous access site on postintervention stent thrombosis for nonthrombotic iliac vein stenting.

Objective: Prior literature suggests that routine femoral vein (FV) puncture is necessary for interrogation of the iliac veins for stenosis to avoid missing common femoral vein (CFV) lesions. However, this can be technically challenging and poses small but increased risks. The purpose of this study was to compare the incidence of stent thrombosis after iliac vein stenting in the treatment of nonthrombotic iliac vein lesions with use of two discrete venous access sites-the CFV and FV.

Methods: During 4 years, we performed 1605 lower extremity venography studies with intravascular ultrasound (IVUS). There were 372 men and 689 women with an average age of 66 years (range, 21-99 years; standard deviation [SD], ± 14.3 years). After IVUS interrogation, 1513 procedures resulted in venous stenting; 964 patients received stent placement in the common iliac vein, 513 in the external iliac vein, 24 involving the CFV, and 12 involving the FV. The venous puncture site, accessed by ultrasound guidance, varied between the CFV and FV per the surgeon's choice and was documented on the basis of the most distal vein area measured by IVUS during the procedure. Patients were followed up with iliocaval and lower extremity duplex ultrasound within 2 weeks and every 3 months thereafter for the first year.

Results: There were 994 patients who received CFV puncture and 611 patients who received FV puncture. In 39 (4.2%) patients receiving CFV punctures with subsequent stent placement, any stent thrombosis developed within 30 days of the intervention; 27 (69.2%) were complete thromboses. In 21 (3.6%) patients who received FV punctures with subsequent stent placement, any stent thrombosis developed within 30 days of intervention; 17 (81.0%) were complete thromboses. There was no significant difference (P = .57) in ≤30-day thromboses between the CFV and FV cohorts. Any in-stent thrombosis developed >30 days after intervention in 18 patients, 11 in limbs that received CFV puncture and 7 with FV puncture (P = .98). Complete stent occlusion occurred in three cases of CFV puncture. No FV punctures led to >30-day complete stent thromboses. The median time to diagnosis of >30-day thrombosis was 11.1 months (range, 2.6-31.9 months; SD, ± 12.86 months). Median follow-up was 20 months (SD, ± 19.18 months).

Conclusions: There was no significant difference between in-stent thrombosis rate and location of initial venous puncture in the setting of outpatient IVUS-guided venography. Both the CFV and FV can be safely used as puncture sites for lower extremity venography.