With the aims of predicting and comparing venous stent outcomes, aiding in communication with patients, and enhancing therapeutic decision-making, researchers have proposed an anatomical classification system for patients with chronic venous obstruction (CVO) of the iliofemoral tract undergoing interventional procedures.
In a paper published in the European Journal of Vascular and Endovascular Surgery (EJVES), Houman Jalaie, Mohammad E Barbati (European Venous Center, Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany) and colleagues—including the International CVO Classification Study Group—outline the results of a retrospective, multicentre study on the newly proposed classification system.
The authors write that their study analysed data from 13 vascular centres and included 1,033 patients with CVO who were treated between 2015 and 2019. They note that patients were classified into five category types: 1) non-thrombotic iliac vein lesion; 2) CVO of the iliac segment; 3) CVO of the iliofemoral segment above the common femoral vein confluence; 4) CVO of the iliofemoral segment extending into the femoral vein or deep femoral vein; and 5) CVO of the iliofemoral segment involving both the deep femoral vein and the femoral vein.
Jalaie and colleagues detail that the mean age of the patients included in the study was 44, with just under 60% being women. They specify that a median of two stents was used for unilateral cases, while a median of five was used for bilateral cases.
Writing in EJVES, the researchers report that primary patency rates for types one to five were 94.9%, 90.3%, 80.8%, 60.6%, and 39.4%, respectively, at 12-month follow-up. “These rates were strongly correlated with the extent of CVO and showed significant differences between each type,” the authors comment.
In addition, Jalaie and colleagues reveal that univariable analysis identified predictors of primary patency loss as the type of CVO, history of deep vein thrombosis, and the total number of stents. In multivariable analysis, they continue, the significant independent predictors of primary patency loss were the type of CVO and the total number of stents.
“The decrease in primary patency over time based on the extent of pathology is indicative of the prognostic value of the proposed classification of the iliofemoral CVO in this analysis,” the authors write in their discussion.
Based on their findings, the authors conclude: “The proposed anatomical classification of iliofemoral CVO will help to predict intervention outcomes and facilitate comparison of stent outcomes in future studies.” However, they stress that “further evaluation and validation in prospective studies are needed to confirm the utility of this classification”.
Highlighting some limitations to their study, Jalaie and colleagues recognise that its retrospective nature, the absence of a core lab for patency determination, and a lack of standardised outcome analysis such as post-thrombotic syndrome scoring, clinical venous severity scores, and quality of life scores, all impact the strength of their conclusions.
Speaking to Venous News following publication of the study, Barbati comments: “In essence, this classification system not only enhances the clinical management of patients with CVO but also contributes to the broader understanding and treatment of venous diseases, ultimately leading to improved patient care and health outcomes.”
