Four-year outcomes following endovascular treatment in patients with post-thrombotic syndrome of the lower extremities

Objective: This study aimed to evaluate the safety and efficacy of endovascular treatment for post-thrombotic syndrome (PTS) in the lower extremities, and to identify risk factors contributing to in-stent restenosis. Methods: Patients with PTS who underwent endovascular treatment at our institution from May 2016 to April 2022 were included in this study. Clinical symptoms were systematically assessed using the Villalta score, the Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification, and the Venous Clinical Severity Score. Primary and secondary patency rates were assessed by duplex ultrasound examination. Risk factors associated with in-stent restenosis were analyzed using univariate and multivariate Cox regression models. A repeated measures analysis of variance was conducted to compare clinical symptom scores before and after treatment. Results: A total of 115 patients were included in the study. The median follow-up duration was 48 months (range, 24-65 months). The primary patency rates at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years were 92.2% +/- 2.5%, 88.7% +/- 3.0%, 81.7% +/- 3.6%, 73.9% +/- 4.1%, 66.6% +/- 4.5%, and 65.3% +/- 4.6%, respectively. Stent restenosis was observed in 38 patients. At 1 year postoperatively, the Venous Clinical Severity Score exhibited a significant reduction of 7.0 (95% confidence interval [CI]. 6.0-8.0; P < .001) relative to preoperative levels. The Villalta score demonstrated a significant decrease of 11.4 (95% CI, 9.4-13.5; P < .001) compared with preoperative levels. Cox regression analysis indicated that a CEAP classification of C5 or C6 (hazard ratio, 2.24; 95% CI, 1.18-4.25; P 1/4 .014) was associated with stent restenosis. Conclusions: Endovascular treatment, with favorable long-term patency rates, is a safe and effective approach for managing PTS. CEAP classification of C5 or C6 has been identified as a risk factor for stent restenosis.