Quality Indicators For The Recanalization Of Chronic Obstructive Iliofemoral Veins In Postthrombotic Syndrome

Background. The recanalization of chronic occlusions of iliofemoral veins in the presence of postthrombotic syndrome (PTS) is becoming increasingly important due to the development of novel stents. So far, no recommendations for quality indicators (QI) have been found.Objectives. The aim of this work was to develop QI for the recanalization of chronic occlusions of iliofemoral veins in the authors' group commissioned by the German Society for Vascular Surgery and Vascular Medicine.Materials and methods. After a bibliographic literature search, QIs were defined from 15 relevant original papers in the English language. After a data extraction phase, these were assigned a preliminary target value based on the reference values.Results. Ten QIs were defined and evaluated in an author consensus, taking into account the central aspects of the QUALIFY criteria. These were divided into process and result QI. Linking the indication to the pathoanatomical-morphological classification, performance of a preprocedural MR-phlebography, use of venous specific stents, intraoperative use of intravascular ultrasound (IVUS), thrombotic events within the first 30 days, technical success, improvement of quality of life, improvement of clinical scores, patency rates, and healing rates of ulcerations qualified according to the QUALIFY criteria.Conclusion. The evidence for the recanalization of chronic obstructive iliofemoral veins has to be considered as low overall due to the enormous heterogeneity of the patient population, the pronounced variability of the stents used, and the lack of cohort comparisons between conservative and recanalizing therapy. The target values for the respective QI generated from the available reference values are therefore recommendations and require validation by future higher quality evidence.