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

Abstract

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.

Keywords

endovascular therapy iliofemoral venous obstruction post-thrombotic syndrome profunda femoral vein

Get full access to this article

View all access options for this article.

References

Zhang

Song

Chen

, et al. Four-year outcomes following endovascular treatment in patients with post-thrombotic syndrome of the lower extremities. J Vasc Surg Venous Lymphat Disord 2025; 13: 102260.

Kahn

SR.

The post-thrombotic syndrome: progress and pitfalls. Br J Haematol 2006; 134: 357–365.

Neglén

Hollis

Olivier

Raju

Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg 2007; 46: 979–990.

Ardita

Galati

Miglioranza

, et al. Endovascular treatment of chronic ilio-femoral vein obstruction with extension below the inguinal ligament in patients with post-thrombotic syndrome. J Vasc Surg Venous Lymphat Disord 2024; 12: 101816.

Razavi

Jaff

Miller

LE.

Safety and effectiveness of stent placement for iliofemoral venous outflow obstruction: Systematic review and meta-analysis. Circ Cardiovasc Interv 2015; 8: e002772.

Peng

Lin

Endovascular therapy for iliac vein compression syndrome: Superior outcomes in non-thrombotic patients and risk factors for stent restenosis. Am J Transl Res 2025; 17: 3521–3529.

Jalaie

Barbati

Piao

, et al. Prognostic value of a classification system for iliofemoral stenting in patients with chronic venous obstruction. Eur J Vasc Endovasc Surg 2025; 69: P315–322.

Raju

Neglén

Percutaneous recanalization of total occlusions of the iliac vein. J Vasc Surg 2009; 50: 360–368.

Espitia

Douane

Hersant

, et al. Predictive factors of stent patency in iliofemoral venous diseases in a multicentre cohort study. Eur J Vasc Endovasc Surg 2023; 65: 564–572.

10.

Wang

, et al. Age-related risk factors and manifestations in deep venous thrombosis. Phlebology 2026; 41: 39–46.

11.

Schünemann

Cushman

Burnett

, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2018; 2: 3198–3225.

12.

Kearon

Akl

Comerota

, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 suppl): e419S–e496S.

13.

Sang

Qian

Meng

Outcome of endovascular treatment in postthrombotic syndrome. Ann Vasc Surg 2014; 28: 1493–1500.

14.

Chen

Xiong

Zhou

WM.

Differences in limb, age and sex of Chinese deep vein thrombosis patients. Phlebology 2015; 30: 242–248.

15.

Barco

Klok

Mahé

, et al. Impact of sex, age, and risk factors for venous thromboembolism on the initial presentation of first isolated symptomatic acute deep vein thrombosis. Thromb Res 2019; 173: 166–171.

16.

Marston

Browder

Iles

, et al. Early thrombosis after iliac stenting for venous outflow occlusion is related to disease severity and type of anticoagulation. J Vasc Surg Venous Lymphat Disord 2021; 9: 1399–1407.e1.

17.

De Maeseneer

Kakkos

Aherne

, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg 2022; 63: 184–267.

18.

Iakovou

Schmidt

Bonizzoni

, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 2005; 293: 2126–2130.

19.

Van Werkum

Heestermans

Zomer

, et al. Predictors of coronary stent thrombosis: The Dutch Stent Thrombosis Registry. J Am Coll Cardiol 2009; 53: 1399–1409.

20.

Neglén

Raju

In-stent recurrent stenosis in stents placed in the lower extremity venous outflow tract. J Vasc Surg 2004; 39: 181–187.

21.

Neglén

Raju

Proximal lower extremity chronic venous outflow obstruction: Recognition and treatment. Semin Vasc Surg 2002; 15: 57–64.

22.

Rosales

Sandbaek

Jørgensen

JJ.

Stenting for chronic post-thrombotic vena cava and iliofemoral venous occlusions: Mid-term patency and clinical outcome. Eur J Vasc Endovasc Surg 2010; 40: 234–240.