FOR THE MEDICAL PRACTITIONER
Vascular Surgery
doi: 10.25005/2074-0581-2026-28-3-834-850
INITIAL EXPERIENCE WITH VENOUS STENTING FOR POST-THROMBOTIC DISEASE OF THE LOWER EXTREMITIES: A PILOT STUDY

A.D. GAIBOV1, D.D. SULTANOV1,2, O. NEMATZODA1,2, K.A. ABDUSAMADOV2, D.K. RAKHMONOV2, F.M. MAKHMADALIZODA2, A.K. BARATOV2

1Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
2Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Tajikistan

Objective: To evaluate the initial outcomes of venous stenting in patients with post-thrombotic disease (PTD) of the lower extremities (LE).

Methods: We analyzed immediate outcomes after stenting the iliofemoral venous segment in 10 patients (7 women, 3 men) with PTD. The average disease duration was 32.5±6.5 months. Chronic venous insufficiency (CVI) of the LE was classified as Class C3 in half of the patients and Class C4 in the other half. Patient age ranged from 33 to 57 years, with a mean age of 39.2±6.4 years. The malleolar circumference of the affected limb averaged 40.8±9.5 cm, compared to 30.3±7.8 cm for the healthy limb (p=0.024). Thigh circumferences of the affected limb at the lower, middle, and upper segments averaged 49.6±8.3 cm, 58.5±10.2 cm, and 69.1±11.4 cm, respectively; corresponding measurements for the contralateral limb averaged 42.4±7.9 cm, 51.6±9.8 cm, and 62.3±10.4 cm (p>0.05 for all paired segments). Baseline LE PTD averaged 12.2±1.2 points on the Vilalta scale, while the Venous Clinical Severity Score (VCSS) ranged from 12 to 26 points, with an average of 21.4±3.1 points.

Results: Indications for endovascular intervention included post-thrombotic changes in the vein walls presenting as lumen stenosis or occlusion, alongside progressive CVI refractory to conservative management. We used Venovo® Venous Stent Systems (Angiomed GmbH & Co. Medizintechnik KG, Germany) in all cases. We achieved technical success in 100% of procedures. The average length of the affected venous segment was 124.5±10.5 mm, and the average length of the implanted stents was 145.5±10.5 mm. No intraoperative or early postoperative complications were reported. Patients were discharged in satisfactory condition at an average of 3.2±0.4 days post-surgery. Follow-up assessment at a mean of 4.2±0.4 months demonstrated a statistically significant reduction in symptom severity, with mean Vilalta and VCSS scores decreasing to 5.4±0.6 and 13.2±2.6 points, respectively (p<0.001). Long-term outcomes remain under evaluation.

Conclusion: Endovascular angioplasty and venous stenting should be considered the treatment of choice for severe forms of post-thrombotic disease, particularly occlusive variants, when conservative therapy fails. Key benefits include minimal surgical trauma, the ability to use local anesthesia, short hospital stays, and rapid recovery.

Keywords: Post-thrombotic disease, chronic venous insufficiency, iliac vein occlusion, stenting, endovascular treatment.

Download file:

References
  1. Stoyko YuM, Kirienko AI, Zatevakhin II, Pokrovsky AV, Karpenko AA, Zolotukhin IA, i dr. Rossiyskie klinicheskie rekomendatsii po diagnostike i lecheniyu khronicheskikh zabolevaniy ven [Russian clinical recommendations on diagnosis and treatment of chronic venous diseases]. Flebologiya. 2018(3):146-240. https://doi.org/10.17116/flebo20187031146
  2. Sultanov DD, Kalmykov EL, Gaibov AD, Soliev OF, Dodkhoev JS, Nematzoda O. Epidemiologiya khronicheskikh zabolevaniy ven sredi sel’skikh zhiteley Tadzhikistana [ Epidemiology of chronic venous diseases among rural residents of Tajikistan]. Flebologiya. 2019;13(4):307-13. https://doi.org/10.17116/ flebo201913041307
  3. Gloviczki P, Dalsing MC, Eklöf B, Lurie F, Wakefield TW, Gloviczki ML. Handbook of venous and lymphatic disorders: Guidelines of the American Venous Forum, Fourth Edition. Boca Raton, Fl, USA: CRC Press; 2017. 48 p. https://doi. org/10.1201/9781315382449-2
  4. Barbati ME, Avgerinos ED, Baccellieri D, Doganci S, Lichtenberg M, Jalaie H. Interventional treatment for post-thrombotic chronic venous obstruction: Progress and challenges. J Vasc Surg Venous Lymphat Disord. 2024;12(5):101910. https://doi.org/10.1016/j.jvsv.2024.101910
  5. De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, 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(2):184-267. https://doi.org/10.1016/j. ejvs.2021.12.024
  6. Gaibov AD, Sadriev ON, Kalmykov EL, Sultanov DD, Kamolov RS. Ostryy ileofemoral’nyy venoznyy tromboz [Acute ileofemoral venous thrombosis]. Kardiologiya i serdechno-sosudistaya khirurgiya. 2016;9(5):63-8. https://doi. org/10.17116/kardio20169563-68
  7. Nematzoda O, Gaibov AD, Kalmykov EL, Baratov AK. COVID-19-assotsiirovannyy arterial’nyy tromboz [COVID-19-related arterial thrombosis]. Vestnik Avitsenny [Avicenna Bulletin]. 2021;23(1):85-94. https://doi.org/10.25005/2074-0581- 2021-23-1-85-94
  8. Shekarchian S, Van Laanen J, Esmaeil Barbati M, Vleugels MJ, Nelemans P, Razavi MK, et al. Editor's Choice – Quality of life after stenting for iliofemoral venous obstruction: A randomised controlled trial with one year follow up. Eur J Vasc Endovasc Surg. 2023;66(5):678-85. https://doi.org/10.1016/j.ejvs.2023.07.044
  9. ACP Guidelines Committee. Management of obstruction of the femoroiliocaval venous system. 2015. 1-8.
  10. Menez C, Rodiere M, Ghelfi J, Seinturier C, Martinelli T, Imbert B, et al. Endovascular treatment of post-thrombotic venous ilio-femoral occlusions: Prognostic value of venous lesions caudal to the common femoral vein. Cardiovasc Intervent Radiol. 2019;42(8):1117-27. https://doi.org/10.1007/s00270-019- 02214-9
  11. Ahmed T, Chait J, Kibrik P, Alsheekh A, Ostrozshynskyy Y, Hingorani A, Ascher E. Dyeless iliac vein stenting. Vascular. 2021;29(3):424-28. https://doi. org/10.1177/1708538120960869
  12. Seager MJ, Busuttil A, Dharmarajah B, Davies AH. Editor's Choice – A systematic review of endovenous stenting in chronic venous disease secondary to iliac vein obstruction. Eur J Vasc Endovasc Surg. 2016;51(1):100-20. https://doi. org/10.1016/j.ejvs.2015.09.002
  13. Antignani PL, Lazarashvili Z, Monedero JL, Ezpeleta SZ, Whiteley MS, Khilnani NM, et al. Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. Int Angiol. 2019;38:265-83. https://doi.org/10.23736/ S0392-9590.19.04237-8
  14. Melian CM, Giannopoulos S, Volteas P, Virvilis D. Intravascular ultrasound in treating iliac vein compression with endovascular stenting: A necessary tool for optimal outcomes. Vasc Endovascular Surg. 2023;57(3):299-305. https://doi. org/10.1177/15385744221145143
  15. Oganesyan OA, Bukhtoyarov AYu, Lyaskovskiy KO, Nikitin SP, Chekhoev SV, Soloninkin IS, i dr. Pervyy opyt endovaskulyarnoy rekanalizatsii i stentirovaniya khronicheskoy posttromboticheskoy okklyuzii nizhney poloy veny i obeikh obshchikh podvzdoshnykh ven v Krasnodarskom krae [First experience of endovascular recanalization and stenting of the chronic post-thrombotic occlusion of the inferior vena cava and both common iliac veins in Krasnodar krai]. Kubanskiy nauchnyy meditsinskiy vestnik. 2020;27(3):125-38. https://doi. org/10.25207/1608-6228-2020-27-3-125-138
  16. Wang S, He Y, Xin S, Zhang J. Iliac vein stenting is a safe and effective treatment for iliac vein compression syndrome: A systematic review of Chinese data. Phlebology. 2020;35(10):752-70. https://doi.org/10.1177/0268355520940910
  17. Williams ZF, Dillavou ED. A systematic review of venous stents for iliac and venacaval occlusive disease. J Vasc Surg Venous Lymphat Disord. 2020;8(1):145- 53. https://doi.org/10.1016/j.jvsv.2019.08.015
  18. Gagne PJ, Gagne N, Kucher T, Thompson M, Bentley D. Long-term clinical outcomes and technical factors with the Wallstent for treatment of chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord. 2019;7(1):45- 55. https://doi.org/10.1016/j.jvsv.2018.07.016
  19. Jayaraj A, Noel C, Kuykendall R, Raju S. Long-term outcomes following use of a composite Wallstent-Z stent approach to iliofemoral venous stenting. J Vasc Surg Venous Lymphat Disord. 2021;9(2):393-400.e2. https://doi.org/10.1016/j. jvsv.2020.08.020
  20. Jiang L, Zhuang H, Song T, Li XQ. Clinical outcomes at 3 years after stenting for thrombotic and non-thrombotic iliac vein compression syndrome patients. Clin Appl Thromb Hemost. 2024;30:10760296231220053. https://doi. org/10.1177/10760296231220053
  21. Razavi MK, Black S, Gagne P, Chiacchierini R, Nicolini P, Marston W, et al. Pivotal study of endovenous stent placement for symptomatic iliofemoral venous obstruction. Circ Cardiovasc Interv. 2019;12(12):8268. https://doi.org/10.1161/ CIRCINTERVENTIONS.119.008268
  22. Murphy E, Gibson K, Sapoval M, Dexter DJ, Kolluri R, Razavi M, et al. Pivotal study evaluating the safety and effectiveness of the abre venous self-expanding stent system in patients with symptomatic iliofemoral venous outflow obstruction. Circ Cardiovasc Interv. 2022;15(2):e010960. https://doi.org/10.1161/ CIRCINTERVENTIONS.121.010960
  23. Lichtenberg MKW, Stahlhoff WF, Stahlhoff S, Özkapi A, Breuckmann F, de Graaf R. Venovo venous stent for treatment of non-thrombotic or post-thrombotic iliac vein lesions – Long-term efficacy and safety results from the Arnsberg venous registry. Vasa. 2021;50(1):52-8. https://doi.org/10.1024/0301-1526/a000893
  24. Zhong W, Lou Y, Qiu C, Li D, Zhang H. Antithrombotic therapy after iliac vein stenting. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49(1):131-6. https://doi. org/10.3785/j.issn.1008-9292.2020.02.15
  25. Raju S, Powell T, Kuykendall R, Jayaraj A. A unique complication of double barrel Wallstent technique in iliac-caval stenting. J Vasc Surg Cases Innov Tech. 2021;7(2):211-4. https://doi.org/10.1016/j.jvscit.2021.01.004

Authors' information:

Gaibov Alidzhon Dzhuraevich,
Corresponding Member of National Academy of Sciences of Tajikistan, Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: AAC-9879-2020
Scopus ID: 6602514987
ORCID ID: 0000-0002-3889-368X
SPIN: 5152-0785
Author ID: 293421
E-mail: gaibov_a.d@mail.ru

Sultanov Dzhavli Davronovich,
Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University; Deputy Director for Science, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: AAC-7784-2019
Scopus ID: 36922139600
ORCID ID: 0000-0001-7935-7763
SPIN: 9762-8395
Author ID: 445360
E-mail: sultanov57@mail.ru

Nematzoda Okildzhon,
Candidate of Medical Sciences, Leading Researcher, Republican Scientific Center for Cardiovascular Surgery; Assistant Professor of the Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: F-8729-2018
Scopus ID: 56469644700
ORCID ID: 0000-0001-7602-7611
SPIN: 2408-9107
Author ID: 929575
E-mail: sadriev_o_n@mail.ru

Abdusamadov Komildzhon Abdulmarobovich,
Candidate of Medical Sciences, Endovascular Surgeon, Department of Endovascular Surgery, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0002-8072-5751
SPIN: 4014-3066
Author ID: 1137909
E-mail: dr.aka_84@mail.ru

Rakhmonov Dzhamshed Karimovich,
Endovascular Surgeon, Department of Endovascular Surgery, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0003-2691-4065
E-mail: dzhamshed-r@mail.ru

Makhmadalizoda Fayziddin Makhmadali,
Candidate of Medical Sciences, Leading Researcher, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0001-5954-9522
SPIN: 7517-0607
Author ID: 916-624
E-mail: dr.fayzidin@mail.ru

Baratov Alisher Kenjaevich,
Candidate of Medical Sciences, Associate Professor, Endovascular Surgeon, Department of Endovascular Surgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: AAE-6818-2019
Scopus ID: 8249648700
ORCID ID: 0000-0002-8072-5751
SPIN-код: 6576-1680
Author ID: 268956
E-mail: alishbar@rambler.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Nematzoda Okildzhon
Candidate of Medical Sciences, Leading Researcher, Republican Scientific Center for Cardiovascular Surgery; Assistant Professor of the Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Sanoi str., 33

Tel.: +992 (915) 250055

E-mail: sadriev_o_n@mail.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

Materials on the topic:
  1. RUPTURE OF A TRUE SPLENIC ARTERY ANEURYSM WITH RECURRENT GASTRIC BLEEDING: A CASE REPORT
  2. PERSONALIZED ASSESSMENT OF THE RISK OF SEVERE VARICOSE VEINS OF THE LOWER LIMBS BASED ON BIOCHEMICAL AND GENETIC INDICATORS
  3. PERIARTERIAL DIGITAL SYMPATHECTOMY IN THE TREATMENT OF RAYNAUND’S PHENOMENON

◄ Back to the list