SIR position statement outlines appropriate use of endovascular management for chronic iliofemoral venous occlusions

Alda Tam

The Society of Interventional Radiology (SIR) has published a position statement offering recommendations on the management of chronic iliofemoral venous obstruction with endovascular placement of metallic stents. The statement, published online in the Journal of Vascular and Interventional Radiology, is a companion to the 2022 statement on the treatment of acute iliofemoral deep vein thrombosis.

In the new statement, a multidisciplinary group of experts from interventional radiology (IR), vascular medicine, and vascular surgery indicated that among patients with chronic venous disease and iliofemoral venous obstruction, those who are experiencing life-disrupting symptoms or disability and who have anatomic features that favour long-term patency, may be more likely to benefit from stenting as an adjunct to conservative management. Most other patients with chronic iliofemoral venous occlusions would be better served with conservative management alone, such as use of medical therapy and compression garments, and re-evaluated over time.

“There is strong consensus on the panel that excellent clinical decision-making around venous stent placement will be most likely when the treating physician has strong familiarity with key clinical considerations around optimal diagnosis and evaluation of iliac vein obstruction, as well as assessment of its clinical severity and life impact,” said Suresh Vedantham, interventional radiologist and professor at Washington University School of Medicine (St Louis, USA), who is the lead author of the statement. “The statement provides a framework against which IR physicians can review their practices, address knowledge gaps, deliver treatment effectively, and ensure that patients selected for stent placement are likely to benefit from it.”

The statement authors note that additional research is needed to better guide the use of stents in this patient population. If completed, two ongoing multicentre randomised controlled trials—C-TRACT and BEST—can enable a strong and unbiased understanding of the treatment effects associated with the addition of venous stent placement to standard care, Vedantham said.

“For both studies, success will depend on whether providers make it a priority to refer patients to study sites,” he said. “It is hoped that physicians will promote the welfare of future venous disease patients by actively choosing now to enrol eligible patients in ongoing clinical trials that are designed to generate high-quality evidence on the benefits, risks, and best practices around venous stent placement.”

While this research proceeds, SIR believes that adherence to the statement’s recommendations will enable judicious use of endovascular therapy in a manner that optimises benefit and minimises harm.

“The new statement provides the best assessment of the current evidence we have to date, and SIR is grateful to the authors for their time and energy in ensuring that we have evidence-based guidance for the treatment of chronic venous occlusions,” said SIR President Alda L Tam, interventional radiologist and professor at the University of Texas MD Anderson Cancer Center (Houston, USA). “SIR remains committed to supporting ongoing and future research in this area to ensure that physicians have the information they need to optimize patient care now and in the future.”


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