ENDOVASCULAR STENTING OF OBSTRUCTIVE LESIONS OF VARYING EXTENT IN PATIENTS WITH POST-THROMBOTIC SYNDROME

Deep vein thrombosis (DVT) and its associated post-thrombotic syndrome (PTS) represent a significant medical and social challenge, particularly in cases involving the iliofemoral venous segment. Approximately 70% of patients with proximal venous thrombosis experience complete occlusion or partial recanalization, leading to persistent venous outflow obstruction and progression of PTS. Current treatment methods, including endovascular desobstruction and venous stenting, show mixed clinical results, highlighting the need to study the risk factors affecting the efficacy of these interventions.Objective: To evaluate the effectiveness and safety of endovascular treatment in patients with post-thrombotic proximal obstruction of the iliofemoral venous segment of varying lengths.Materials and Methods: This retrospective study included 99 patients with PTS complicated by post-thrombotic obstruction of the iliofemoral venous segment who underwent venous stenting between 2016 and 2024. Patients were divided into two groups based on the length of the iliofemoral segment occlusion. Clinical assessment was conducted using the international CEAP classification and clinical questionnaires such as Villalta, VCSS, and CIVIQ-20. The primary outcomes of treatment effectiveness were reductions in scores on the Villalta, VCSS, and CIVIQ-20 scales, as well as confirmation of patency of the stented iliofemoral segment via ultrasound duplex scanning three months post-discharge.Results: Technical success of stenting was achieved in all patients across both groups. Both groups showed statistically significant improvements in clinical scores (Villalta, VCSS, CIVIQ-20; p<0.001). In the early postoperative period, stent patency was 93.2% in Group I (localized occlusion) and 83.3% in Group II (extensive occlusion). Key risk factors for stent thrombosis in the early postoperative period were identified: occlusion involving more than one venous segment and peak blood flow velocity below 13 cm/s.Conclusion: Endovascular stenting of the iliofemoral segment is an effective and safe treatment for patients with obstructive lesions and severe PTS. However, the risk of postoperative thrombosis remains high, particularly in cases of extensive obstructive lesions. Peak blood flow velocity within the stent zone is a significant prognostic factor for thrombosis, emphasizing the need for a personalized approach to patient management.