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Cho LD, Bai H, Collins LC, Chen J, Cooke PV, Kang Y, Vasan V, Kim J, Gonzalez C, Dionne E, Kim SY, Ting W. Race differences in iliofemoral vein stenting for chronic venous insufficiency. Vascular 2024; 32:385-390. [PMID: 36395482 DOI: 10.1177/17085381221140612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Major disparities in outcomes by race are present throughout vascular surgery, yet little has been published on iliac vein stent outcomes by race. This retrospective study assessed iliac vein stent outcomes by patient race. METHODS Patients who underwent iliac vein stenting at a single institution for chronic venous insufficiency (CVI) from 2011 to 2021 were reviewed. Demographic, preoperative, perioperative, and postoperative data were collected. Self-reported race groups included Asian, Black, Hispanic, and White. Univariate differences were analyzed using χ2 tests for categorical variables and 1-way ANOVA for continuous variables. Outcomes included change in Venous Clinical Severity Score (VCSS) at interval timepoints relative to a preoperative baseline and reinterventions. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. Multivariate regression models controlled for demographic and comorbidity characteristics. RESULTS A total of 827 patients were included. Asian patients were younger and had a greater proportion of male patients, lower Body mass index (BMI), less smoking history, and fewer comorbidities. White patients were more likely to have a history of deep vein thrombosis (DVT). White patients presented with the most severe CVI symptoms as defined by both Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and preoperative VCSS composite scores. There were no differences in acute DVT, number of stents deployed, and bilateral versus unilateral stent placement. Black patients had the longest average days of follow-up, followed sequentially by Hispanic, White, and Asian. Black patients had the most reinterventions, while Asian patients had the fewest. Asian patients were less likely to have a major reintervention. No differences in VCSS composite or change in VCSS were observed. CONCLUSIONS In patients with CVI, Asian patients presented younger and healthier, while White patients presented with the most severe symptoms. No differences were observed in VCSS outcomes, though Black patients had the most reinterventions.
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Affiliation(s)
- Logan D Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Halbert Bai
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jenny Chen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter V Cooke
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yeju Kang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vikram Vasan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinseo Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Elyssa Dionne
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sung Yup Kim
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Bozeman PK, Russo E, Whipple MO. The need for iliac vein stenting in women of child bearing age and the compatibility of iliac vein stents in pregnancy. JOURNAL OF VASCULAR NURSING 2024; 42:80-81. [PMID: 38555182 DOI: 10.1016/j.jvn.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
| | - Emily Russo
- Hartford Healthcare Medical Group, Hartford, CT
| | - Mary O Whipple
- School of Nursing, University of Minnesota, Minneapolis, MN
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Dionne E, Bai H, Collins L, Cho LD, Gonzalez C, Vasan V, Cooke PV, Kim J, Kang Y, Tadros RO, Ting W. Gender Differences in Iliofemoral Vein Stenting for Chronic Venous Insufficiency. Vasc Endovascular Surg 2023:15385744231154330. [PMID: 36689565 DOI: 10.1177/15385744231154330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Little is known about gender's role in chronic venous insufficiency (CVI). The aim of this study was to evaluate the impact of gender on outcomes of iliac vein stenting(IVS) for CVI. METHODS 866 patients who underwent vein stenting for CVI at one institution from August 2011 to June 2021 were analyzed via retrospective review. Patients were followed up to 5 years after initial stent placement. Presenting symptoms were quantified using Venous Clinical Severity Score(VCSS), Clinical Assessment Score(CAS), and Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class. Reoperations after initial IVS were recorded. Major reoperations were defined as iliac interventions using venography. Minor reoperations were defined as thermal ablation. Multivariate logistic regression models were used determine odds of any and major reintervention. RESULTS Compared to females, males pre-operatively presented with a higher mean CEAP class (3.6 vs .3.3; P < .001), VCSS composite (11.3 vs .9.9; P < .001), and smoking history (134 vs .49; P < .001). The 2 groups were similar in age (P = .125), BMI(P = .898), previous DVT (P = .085), diabetes (P = .386), hypertension (P = 1.0), and CAD (P = .499). Multivariate analyses revealed no association between gender and any reintervention (OR, 1.02; 95%CI, .71-1.46; P = .935) or gender and major reintervention (OR, 1.39; 95% CI, .86-2.23 P = .177). There were no differences in number of stents placed (P = .736) or symptomatic improvement at 1 month (P = .951), 3 months (P = .233), 6 months(P = .068), and greater than 1 year (P = .287). At the 1 year follow-up, the male cohort had higher CAS values than females P = .034). Males had larger reduction in composite VCSS than women at 1 year (5.1 vs. 3.8; P = .003) and 3 years (5.3 vs .3.7; P = .031) of follow-up and similar levels of improvement in post-op (4.0 vs .3.5; P = .059), 2 years (4.3 vs .3.8; P = .295), 4-years (5.1 vs .4.6; P = .529), 5 years (5.6 vs .4.2; P = .174), and 6 years (5.93vs.3.3 P = .089). CONCLUSIONS In a single site study of IVS in patients with CVI, males tended to present worse symptoms than females. After surgery, however, both cohorts showed improvement, and both seemed to improve to the same degree of residual symptoms.
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Affiliation(s)
- Elyssa Dionne
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Halbert Bai
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lucas Collins
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Logan D Cho
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Gonzalez
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vikram Vasan
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter V Cooke
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinseo Kim
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yeju Kang
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rami O Tadros
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Windsor Ting
- Department of Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Intravascular ultrasound evaluation during iliofemoral venous stenting is associated with improved midterm patency outcomes. J Vasc Surg Venous Lymphat Disord 2022; 10:1294-1303. [PMID: 35872140 DOI: 10.1016/j.jvsv.2022.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/12/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Intravascular ultrasound (IVUS) examination is increasingly used in the treatment of iliofemoral venous disease and provides more sensitive and specific detection of stenotic lesions when compared with traditional multiplanar venography alone. Correlations with deep venous stent patency, however, have not yet been investigated. The objective of the study was to evaluate the impact of the use of IVUS examination in addition to multiplanar venography on iliofemoral venous patency. METHODS Consecutive patients who underwent stenting for symptomatic thrombotic or nonthrombotic iliofemoral venous lesions (NIVLs) between 2014 and 2020 at a single institution were identified and divided into two groups based on whether IVUS examination was used before stent deployment in addition to multiplanar venography compared with venography alone. A retrospective review of demographic, operative, and follow-up data was performed. Thirty-day and 2-year stent patency were measured as primary end points. χ2 analysis, logistic regression models, and Kaplan-Meier survival analysis were used to determine outcomes. Technical details and outcomes were additionally examined among patients treated for acute deep venous thrombosis, post-thrombotic syndrome, or NIVLs separately on subgroup analysis. RESULTS We identified 150 patients (173 limbs, 23 bilateral) who underwent iliofemoral stenting during the study period at our institution (mean age: 48.8 ± 16.8 years, 61% female). Adjunctive IVUS utilization before stent deployment was reported in 69 of 173 (39.9%) treated limbs. IVUS examination was more likely to be used in patients who underwent stenting for NIVLs compared with thrombotic disease (41.0% vs 11.2%, P < .01). There was no difference in the number of stents deployed between IVUS and non-IVUS cohorts. However, IVUS examination was associated with the increased total length of the stent deployed (126 ± 56 vs 112 ± 48 mm, P = .04) and a higher rate of infrainguinal stent extension (17.4% vs 6.7%, P = .03). In addition, mean stent diameter was significantly higher when IVUS examination was performed before stent placement (16.3 ± 3.7 vs 15.2 ± 1.9 mm, P < .01). Both 30-day (98.5% vs 89.4%, P = .02) and 2-year (90.3% vs 78.7%, P = .03) primary patency were significantly higher in the IVUS cohort. Adjunctive IVUS use was found to significantly protect against stent reintervention at 2 years on adjusted Cox regression analysis (hazard ratio: 0.22, 95% confidence interval: 0.07-0.71, P = .01). CONCLUSIONS Adjunctive IVUS utilization is associated with differences in stent diameter and length selections as well as landing segments in the treatment of thrombotic and nonthrombotic iliofemoral venous disease. IVUS examination before stent deployment significantly protects against 30-day and 2-year stent reintervention when compared with the use of multiplanar venography alone. These data provide stronger evidence for routine IVUS use in addition to venography before iliofemoral venous stenting.
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