Race differences in iliofemoral vein stenting for chronic venous insufficiency

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.

A Review of Healthcare Disparities Relevant to Interventional Radiology

“…95 In terms of deep vein interventions, a study examining patients who underwent iliac vein stenting suggested that Black patients have a higher reintervention rate and the longest average follow-up after endovascular treatment, followed by Hispanic, White, and Asian patients. 96 Studying the use of different procedures (standalone ablation, ablation with phlebectomy, and ultrasound-guided foam sclerotherapy with ablation and phlebectomy), Hispanic patients required the fewest overall procedures, whereas Black patients required the highest number of procedures to achieve an optimal result. Postprocedural outcomes were measured using revised Venous Clinical Severity Scores (rVCSSs) among racial groups.…”