Title: Comparison of Iliofemoral Vein Stenting in Octogenarians and Older to the Younger Population
Abstract: Octogenarians and nonagenarians represent a significant proportion of patients undergoing vein stenting for chronic proximal venous outflow obstruction (PVOO). This study compares symptomatic improvement after iliac vein stenting in this patient cohort with younger patients undergoing intervention. We retrospectively reviewed 481 patients with chronic PVOO from August 2011 to November 2018 at a single center. Presenting symptoms were quantified using venous clinical severity score (VCSS) and CEAP class. Intraoperative findings were recorded. Clinical outcomes were measured using our group's Clinical Assessment Score (CAS) (symptoms worsened = −1, no change = 0, mild improvement = 1, significant improvement = 2, and complete symptom resolution = 3). Reoperations after initial iliac vein stenting were recorded. Major reoperations were defined as venogram and iliac interventions. Minor reoperations included endovenous laser ablation. Compared with younger patients, elderly patients, ages 80 years or older, had greater incidence of diabetes (36.4% vs 18.2%; P = .021), higher intraoperative deep vein thrombosis (DVT) (36.4% vs 19.3%; P = .034), and lower proportion of prior vein surgery (21.2% vs 52.3%; P = .001). The two groups were similar in terms of gender (P = .574), history of DVT (P = .249), smoking history (P = .999), and composite VCSS (P = .157) (Table). Perioperatively, the two groups were similar on number of stents deployed (2.15 vs 2.25; P = .577), whether bilateral stents were deployed (54.5% vs 60.4%; P = .628), and acute DVT (0% vs 2.3%; P = .843). Elderly patients had a greater proportion hospitalized for over 24 hours (6.2% vs 0.7%; P = .038), whereas younger patients had a higher proportion of subsequent minor (15.6% vs 39.1%; P = .005) and major (25% vs 24.6%; P = .3081) reoperations. The days from surgery to reoperation between the two groups was similar (346 vs 338 days; P = .934) as were the days of follow-up (707 vs 750 days; P = .673). Comparisons of long-term outcome improvements measured using our group's CAS revealed no differences at 30 days (P = .071), 90 days (P = .411), 6 months (P = .623), 1 year (P = .205), and over 1 year (P = .804) (Table), with most patients significantly improved or mildly improved after iliac vein stenting (Fig). Despite greater morbidity among these elderly patients, symptomatic relief occurred after iliac vein stent placement, and outcomes were similar to younger patients.TableComparison of elderly patients over age 80 with younger patients undergoing vein stent placement for proximal venous outflow obstruction in iliofemoral veinsVariablesYoung, No. (%)Elderly, No. (%)P value(n = 446)(n = 35)Baseline CharacteristicsMean age, years (SD)58.54 (11.65)84.66 (3.45)<.001Gender (male)188 (42.2)17 (48.6).574EthnicityAsian339 (76.0)18 (51.4)<.001Black26 (5.8)0 (0.0)Caucasian27 (6.1)16 (45.7)Hispanic43 (9.6)1 (2.9)Other11 (2.5)0 (0.0)History of DVT65 (14.6)8 (23.5).249Intraoperative DVT86 (19.3)12 (36.4).034CEAP Class02 (0.4)0 (0.0).00112 (0.4)0 (0.0)212 (2.7)0 (0.0)3310 (69.7)13 (38.2)469 (15.5)11 (32.4)515 (3.4)1 (2.9)635 (7.9)9 (26.5)Mean composite VCSS (SD)11.08 (4.26)9.97 (5.19).157Diabetes81 (18.2)12 (36.4).021Smoking history88 (19.8)6 (18.2).999Prior vein surgery232 (52.3)7 (21.2).001Bilateral stents269 (60.4)18 (54.5).628Mean number of stents (SD)2.25 (0.98)2.15 (0.91).577Hospitalized > 24 hours3 (0.7)2 (6.2).038Acute DVT10 (2.3)0 (0.0).843ReoperationMajor105 (24.6)8 (25.0).014Perioperative detailsMinor167 (39.1)5 (15.6)None155 (36.3)19 (59.4)Long-term outcomesMean days from surgery to reoperation (SD)338.19 (369.70)346.77 (286.44).934Mean days of follow-up (SD)750.66 (590.74)707.29 (510.98).673Mean 30-day follow-up score (SD)1.38 (0.79)1.67 (0.83).071Mean 90-day follow-up score (SD)1.62 (0.80)1.76 (0.93).411Mean 6-month follow-up score (SD)1.70 (0.81)1.78 (0.85).623Mean1-year follow-up score (SD)1.66 (0.87)1.91 (0.92).205Mean >1 year follow-up score (SD)1.72 (1.01)1.77 (0.87).804DVT, Deep vein thrombosis; SD, standard deviation; VCSS, venous clinical severity score.Boldface P values represent statistical significance. Open table in a new tab