Journal of vascular and interventional radiology : JVIR · 2026
Endovascular Venous Stenting for Chronic Iliofemoral Venous Obstruction in Post-Thrombotic Syndrome and Non-Thrombotic Iliac Vein Lesion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Prospective Single-Arm Clinical Trials.
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Batra Aarushi, Tyagi Bhumesh, Kumar Ashok, Sood Archana
Аннотация
PURPOSE: To evaluate pooled patency, symptomatic, and safety outcomes following dedicated nitinol venous stent placement for symptomatic chronic iliofemoral venous obstruction (CIVO), and to compare outcomes between post-thrombotic syndrome (PTS) and non-thrombotic iliac vein lesion (NIVL) etiologies.
METHODS: PubMed, Scopus, CENTRAL, and ClinicalTrials.gov were searched from inception to May 2026 for randomized controlled trials and prospective registered single-arm studies evaluating venous stents in symptomatic CIVO. Proportional meta-analysis was conducted using Stata(v19.5). Risk of bias was judged with RoB-2 and ROBINS-I. Certainty of evidence was evaluated with GRADE.
RESULTS: 13 studies (21 arms; n=1450) were included. Pooled 12-month primary patency was 93% (95% CI 90-97; I2=83.17%), declining to 90% and 89% at 24 and 36-months, respectively. Primary patency at 12-months was significantly greater in NIVL (98%; 95% CI 96-99%; I2=59.05%) than PTS (84%; 95% CI 81-87%; I2=0.0%). A mean reduction of 4.76 points in Venous Clinical Severity Score (VCSS) (0-30 scale; higher score indicates greater severity) and 6.40 points in Villalta score (0-33 scale; ≥5 indicates PTS) was observed. Stent thrombosis occurred more frequently in PTS than NIVL. Exploratory analysis of three RCTs demonstrated reduction in VCSS for stent placement versus standard of care (2.24; 95% CI -3.34 to -1.14; I2=0%).
CONCLUSION: Prospective evidence suggests favorable patency and symptom improvement following venous stent placement for symptomatic CIVO, although substantial heterogeneity and low-to-very-low certainty of evidence warrant cautious interpretation. Outcomes differ significantly between PTS and NIVL, reflecting an association between etiology and long-term stent performance.
METHODS: PubMed, Scopus, CENTRAL, and ClinicalTrials.gov were searched from inception to May 2026 for randomized controlled trials and prospective registered single-arm studies evaluating venous stents in symptomatic CIVO. Proportional meta-analysis was conducted using Stata(v19.5). Risk of bias was judged with RoB-2 and ROBINS-I. Certainty of evidence was evaluated with GRADE.
RESULTS: 13 studies (21 arms; n=1450) were included. Pooled 12-month primary patency was 93% (95% CI 90-97; I2=83.17%), declining to 90% and 89% at 24 and 36-months, respectively. Primary patency at 12-months was significantly greater in NIVL (98%; 95% CI 96-99%; I2=59.05%) than PTS (84%; 95% CI 81-87%; I2=0.0%). A mean reduction of 4.76 points in Venous Clinical Severity Score (VCSS) (0-30 scale; higher score indicates greater severity) and 6.40 points in Villalta score (0-33 scale; ≥5 indicates PTS) was observed. Stent thrombosis occurred more frequently in PTS than NIVL. Exploratory analysis of three RCTs demonstrated reduction in VCSS for stent placement versus standard of care (2.24; 95% CI -3.34 to -1.14; I2=0%).
CONCLUSION: Prospective evidence suggests favorable patency and symptom improvement following venous stent placement for symptomatic CIVO, although substantial heterogeneity and low-to-very-low certainty of evidence warrant cautious interpretation. Outcomes differ significantly between PTS and NIVL, reflecting an association between etiology and long-term stent performance.