ABSTRACT
Jason B. Storch, BA
Medical Student
Icahn School of Medicine at Mount Sinai
New York, New York, United States
The incidence of vascular disease increases with age, yet effects of aging on venous stenting outcomes have not been widely explored. We undertook this study comparing patients in various age cohorts to examine differences in presentation and outcomes of iliac vein stenting.
Methods:
A clinical registry of 877 patients who underwent iliac vein stenting for chronic proximal venous outflow obstruction (PVOO) from 2011 to 2021 at a single institution was retrospectively analyzed. Patients of different age cohorts, 19-45 (N=98), 46-65 (N=398), 66-75 (N=197), and 76+ years (N=118), were followed for an average of 743 days after an index stent procedure. Patient symptoms were quantified using Clinical-Etiological-Anatomical-Pathophysiological (CEAP) and Venous Clinical Severity Score VCSS. Post-operative symptom resolution was graded using the clinical assessment score (CAS), which grades symptoms from resolved, significant improvement, mild improvement, no change, or worsened. Minor reoperations were defined as endovenous thermal ablation while major reoperations were defined as any intervention that included a venogram. Multivariate logistic regression models were used to determine odds of any reinterventions.
Results:
Across the age cohorts, incidence of diabetes (5.1% vs. 19.8% vs. 27.6% vs. 35.6%; p< 0.001), hypertension (20.4% vs. 40.2% vs. 72.4% vs. 83.1%; p< 0.001), and CAD (2.2% vs. 8.5% vs. 18.8% vs. 21.4%; p< 0.001) varied significantly. A greater incidence of CEAP 4 (20.4% vs. 24.0% vs. 25.1% vs. 32.5%; p=0.002) and 6 (5.1% vs. 6.5% vs. 9.0% vs. 14.5%; p=0.002) occurred in older cohorts. Intraoperative findings suggestive of a remote DVT appeared more frequently in older cohorts (16.3% vs. 22.8% vs. 25.6% vs. 43.6%; p< 0.001). Patient outcomes at 30 days post-operation show most patients in each cohort reporting significant improvement. The youngest cohort saw the most “mild improvement” and least “significant improvement” while the 66-75 year old cohort saw the most “significant improvement” (43.5% vs. 50.7% vs. 60.3% vs. 58.5%; p=0.047) and least “mild improvement” (41.9% vs. 29.9% vs. 17.4% vs. 22.0 %; p=0.047). The oldest cohort experienced the lowest rates of reoperation (p=0.011) and minor interventions were favored by the youngest cohort (p=0.011).
Conclusions: While older patients presented with more severe disease and an increased incidence of comorbidities than younger patients, they experienced excellent outcomes, with the highest percentage of “complete resolution” of symptoms reported and the lowest rates of reoperation. Of patients who underwent a reoperation, younger patients were more likely to undergo minor interventions. Iliac vein stenting for chronic PVOO should be considered in all age groups for the resolution of venous stenosis symptoms.