Endovenous treatment via profunda femoral vein approach for iliofemoral venous obstruction with inadequate femoral vein inflow

Introduction: This study aimed to evaluate the clinical efficacy of endovenous treatment (ET) via the profunda femoral vein (PFV) approach for iliofemoral venous obstruction with inadequate femoral vein (FV) inflow in patients with severe postthrombotic syndrome (PTS). Methods: A retrospective analysis included 32 patients who underwent this procedure between January 2021 and January 2023. Clinical symptoms were evaluated using the Villalta score and Venous Clinical Severity Score (VCSS) at baseline, 1 year, and 2 years. Patency rates were determined by duplex ultrasonography. Univariate logistic regression analysis was used to identify risk factors for in-stent restenosis (ISR). Results: The mean age of the patients was 65.5 ± 8.9 years, and 56.3% were men. Among 32 patients, technical success was achieved in all cases (100%). Postoperative in-stent thrombosis occurred in 18.8% (6/32) of patients. Kaplan–Meier analysis revealed primary patency rates of 100% ± 0%, 96.9% ± 3.1%, 93.8% ± 4.2%, 87.5% ± 5.9%, and 65.6% ± 8.4% at 1, 3, 6, 12, and 24 months, respectively. ISR developed in 11 patients, all of whom underwent reintervention, yielding a secondary patency rate of 87.5% ± 5.9% at 2 years. Baseline Villalta scores (17.4 ± 5.5) and VCSS (13.2 ± 2.5) significantly decreased to 6.5 ± 3.0 and 5.1 ± 1.8 at 2 years postoperatively (both p < 0.05). Anticoagulation noncompliance and history of iliofemoral deep vein thrombosis (DVT) were independent predictors of ISR. Conclusion: ET via the PFV approach is a safe and effective option for iliofemoral venous obstruction with inadequate FV inflow in severe PTS, providing favorable patency rates and significant symptom relief. Anticoagulation noncompliance and history of iliofemoral DVT are key factors for ISR.