A novel vascular limb salvage clinic for the management of critical limb threatening ischaemia and diabetic foot disease: Our first year results

Abstract

Background: Deep venous stenting has become more popular over the past few years with the advent of dedicated venous stents. Stenting is now commonly used in the treatment of May Thurner syndrome or in patients with post thrombotic syndrome to alleviate venous obstruction. Re-intervention rates for stent thrombosis or stenosis can be high and are a big concern with regards to this treatment. The aim of this study was to assess stent patency and re-intervention rates in patients who had undergone lower limb deep venous stenting in a tertiary vascular unit. In addition, a comparative analysis of stent patency for acute and chronic occlusions was performed. Methods: This was a retrospective single centre study of prospectively collected data. All patients who underwent stenting (with dedicated venous stents) for acute and chronic deep venous disease between November 2011 and June 2018 were included in the study. During the post-stent surveillance programme, duplex ultrasound was used to assess stent patency. Results: Seventy-eight deep venous stents were inserted between November 2011 and June 2018. Ten patients were immediately lost to follow up and were therefore excluded from the analysis. The median age was 41.5 years (range 13-79 years) and twenty-eight procedures were for acute presentations and forty for chronic occlusions. Twenty-two limbs required re-intervention (32%) (thrombolysis, venoplasty and/or additional stent insertion). There was no statistical difference in primary, primary assisted or secondary patency between stents inserted in the acute or chronic setting. The primary patency rate at 12, 24, 48 and 60 months was 84%, 75%, 30% and 30% respectively. The primary assisted patency rates at 12, 24, 48 and 60 months was 91%, 88%, 82% and 82% respectively. The secondary patency rate at 12, 24, 48 and 60 months was 90%, 87%, 82% and 82%. Conclusion: These results demonstrate good overall secondary patency outcomes in patients who have undergone deep venous stent procedures. Thirty-two per cent of patients required re-intervention; this underlines the importance of stent surveillance for timely identification of these individuals. There was no significant difference in patency outcomes comparing stents sited for acute versus chronic disease.

Modernizing vascular services to meet the demands of a changing disease burden

“…The Vascular Society of Great Britain and Ireland CLTI Quality Improvement Programme has identified targets from initial consultation to revascularization of 5 days and 14 days for inpatients and outpatients respectively 8 , supported by evidence that delays of more than 14 days are an independent risk factor for amputation, particularly in patients with diabetes 9 . Vascular centres that have developed new services to achieve this have reported significant reduction in major amputations 10 . Delivery of these targets requires a move away from traditional pathways of care.…”