Unraveling the Hemodynamic Impact of Persistent Iliac Vein Lesions and Physical Therapy Post-Stenting

Stent implantation is a standard treatment for iliac vein compression syndrome (IVCS), but persistent lesions in the stented vein can lead to adverse outcomes. This study investigates the hemodynamic impact of these lesions and the effects of therapeutic strategies post-stenting. A patient-specific model simulating flattened, narrow, and tissue adhesion (TA) lesions was used to analyze key hemodynamic parameters, including Wall Shear Stress (WSS), Oscillatory Shear Index (OSI), Relative Residence Time (RRT), and Flow Resistance (RF). The results show that contralateral venous lesions significantly worsen hemodynamic conditions in the iliac vein after stenting. The adhesion model exhibited significantly higher reflux volumes and more extensive regions of low TAWSS, high OSI, and high RRT compared to the other lesion models. Both active ankle exercises (AAE) and intermittent pneumatic compression (IPC) therapies improved the hemodynamic environment in the stented vein. However, these therapies also worsened blood flow disturbances at the contralateral lesion site. These findings highlight the importance of personalized therapeutic strategies to optimize clinical outcomes following stenting.