The treatment of Iliofemoral venous outflow with dedicated nitinol venous stents has changed treatment options for patients with chronic venous obstruction. In post-thrombotic syndrome the disease often extends from the caval confluence to common femoral vein (CFV) confluence. Paucity of data on the prevalence and long-term sequelae of venous stent compromise exists when stents are placed below the inguinal ligament. We aim to determine the re-intervention rate for stent compromise in stents placed below the inguinal ligament in a tertiary centre.

We carried out a retrospective analysis of prospectively collected data on all patients that underwent iliofemoral venous stenting for treatment of symptomatic chronic venous outflow obstruction, or stenosis, between February 2015 to November 2021. All patients that had technically successful stent implantation were included. All patients had standard preoperative work up including inflow assessment with venography +/- intravascular ultrasound. All the procedures were carried out by the same 2 clinicians. All patients followed our standard anticoagulation and surveillance programmes following the procedure. Stent fractures were defined as loss of stent integrity as seen on venography.

55 patients underwent iliofemoral venous stenting. A total of 132 stents were implanted. 46 patients (84%) had stents extended below the inguinal ligament into the CFV. 3 patients (5%) had stent fractures. All of these occurred in stents extending below the inguinal ligament. Only 2 of these cases (4%) required relining. Stent compression or residual stenosis at the inguinal ligament, without fracture, was identified in 5 cases (11%), where all had a loss of luminal diameter of >50%. In our series, the total re-intervention rate for chronic venous stent-related compromise below the inguinal ligament was 15% (7/46).

There is a low clinically significant fracture rate (6.5%) of stents that are placed below the inguinal ligament into the CFV. In our practice, an overall stent fracture rate of 2.3% is favourably comparable to a rate of 3.6% in the VIRTUS trial. The most common reason for re-intervention is compression, with or without associated in-stent thrombosis. The majority of patients are asymptomatic, and stent compression, or fracture, is identified on surveillance imaging. A robust surveillance schedule is vital to ensure stent compromise is identified early and can be treated as necessary. With 84% of our patients treated for chronic venous occlusive disease having stents implanted below the inguinal ligament, this represents real world practice, which we have demonstrated to be a feasible and safe option. Our patients remain on continued surveillance, and long-term data will be monitored.