Efficacy and Safety of Iliac Vein Stenting in Patients With Different Etiologies of Chronic Iliofemoral Venous Obstruction: A Single-Arm Systematic Review and Meta-Analysis

Abstract

Background:

Chronic iliofemoral venous obstruction (CIVO) is primarily caused by nonthrombotic iliac vein lesions (NIVLs) and postthrombotic syndrome (PTS). Iliac vein stenting (IVS) is widely used for symptomatic CIVO, but outcomes across etiologies have not been comprehensively synthesized.

Methods:

We performed a single-arm systematic review and meta-analysis of 5 electronic databases through August 21, 2025. Studies evaluating IVS for CIVO were included. Primary outcomes were primary and secondary stent patency and changes in clinical scores (venous clinical severity score, revised VCSS, Villalta). Secondary outcomes included ulcer healing, symptom resolution, and major adverse events (MAEs). Subgroup analyses were conducted by etiology (PTS vs NIVL). This systematic review was registered in the PROSPERO database (registration number: CRD420251206932).

Results:

Thirty-seven studies involving 6769 patients were included. Pooled mid-term (12–24 months) primary and secondary patency rates were 82% and 93%, respectively, and long-term (>24 months) rates were 75% and 91%, respectively. Pooled mid-term primary patency was 97% (95% confidence interval [CI]: 96%–99%) for NIVL versus 77% (95% CI: 70%–83%) for PTS (p<0.001). Long-term primary patency remained high in NIVL at 97% (95% CI: 95%–100%) but was significantly lower in PTS at 70% (95% CI: 65%–76%). Clinical scores improved after intervention. The median ulcer healing rate was 75%. The incidence of MAEs was higher in PTS than in NIVL.

Conclusion:

Iliac vein stenting is associated with favorable patency and clinical improvement in CIVO. Outcomes were consistently better in NIVL than in PTS, with lower long-term patency and higher MAEs in PTS. Future studies should focus on optimizing poststenting antithrombotic strategies and improving long-term outcomes, particularly in PTS.

Clinical Impact

This study provides a comprehensive meta-analysis quantifying the impact of etiology, IVUS guidance, and anti-coagulation duration on iliac vein stenting outcomes. The primary innovation lies in the evidence-based differentiation between non-thrombotic lesions (NIVL) and post-thrombotic syndrome (PTS). For clinicians, these findings necessitate etiology-specific management: while NIVL achieves high patency with short-term therapy, PTS requires meticulous procedural optimization (IVUS) and significantly benefits from extended anticoagulation for long-term durability (78% vs. 64%, p = 0.046). These insights drive a shift toward individualized post-stenting protocols, improving patient selection and long-term clinical success in chronic obstructive venous disease.