A systematic review of venous stents for iliac and venacaval occlusive disease

Williams, Zachary; Dillavou, Ellen D.

doi:10.1016/j.jvsv.2019.08.015

Cited by 66 publications

(39 citation statements)

References 42 publications

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“…However, evidence supporting endovascular stenting is currently limited to institutional series or meta-analyses. 8 -10 In a single-center study involving 518 non-thrombotic iliac vein lesions and 464 PTS cases, iliocaval stenting completely relieved pain in 62% and swelling in 32% of patients at 5 years following the procedure. 3 In a recent review by Williams et al, symptomatic relief following stenting varied from 60 to 97%, although a meta-analysis could not be executed due to heterogeneous reporting of symptomatic measures.…”

Section: Discussionmentioning

confidence: 99%

“…3 In a recent review by Williams et al, symptomatic relief following stenting varied from 60 to 97%, although a meta-analysis could not be executed due to heterogeneous reporting of symptomatic measures. 9 Given heterogeneity in stenting outcomes, the ongoing Chronic Venous Thrombosis: Relief with Adjunctive Catheter-Directed Therapy (C-TRACT) trial, a multi-center, phase 3 clinical trial supported by the National Institutes of Health, is assessing iliac venous stenting versus non-invasive management in moderate-to-severe PTS. When completed, this study should provide level 1 evidence regarding iliac vein stenting for PTS.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic and Technical Challenges in the Care of a Complex Patient With Post-Thrombotic Syndrome

Chan

Lee

Roy

et al. 2021

Vasc Endovascular Surg

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Iliofemoral deep vein thrombosis can lead to post-thrombotic syndrome, a costly and morbid condition. Endovascular treatment is increasingly used for symptomatic relief, but clinical success depends on accurate patient evaluation and selection. This case describes the diagnostic and technical challenges in the care of a complex patient with post-thrombotic syndrome following stroke and extensive deep vein thrombosis. It highlights the multi-disciplinary work-up for a patient with post-thrombotic syndrome presenting with confounding symptoms, as well as the importance of considering alternative access for successful lower extremity venous recanalization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic and Technical Challenges in the Care of a Complex Patient With Post-Thrombotic Syndrome

Chan

Lee

Roy

et al. 2021

Vasc Endovascular Surg

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“…42 While there are innumerable studies reporting excellent patency rates and clinical outcomes following deep vein stenting for IFVO, the quality of evidence is low. [43][44][45] Most available studies are small, retrospective, single-site evaluations. 46 A systematic review conducted by Seager et al identified no randomised controlled trials, cohort studies or case-control studies.…”

Section: Discussionmentioning

confidence: 99%

“…A GRADE assessment 47 demonstrated the quality of the evidence to be "low" for ulcer healing and "very low" for other outcomes. 44 Despite the weak quality of evidence, deep vein stenting is relatively effective and safe with low incidence of peri-operative complications and high patency rates, 9,[43][44][45][46] and should be considered as a treatment option while the evidence base improves. 44 Post-operative anticoagulation decreases complication rates such as in-stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Deep Vein Stenting of Symptomatic Post-Thrombotic and Non-Thrombotic Iliac Vein Stenotic Lesions: A Multicentre Cohort Experience from Singapore

Lim

Damodharan

Chan

et al. 2020

Ann Acad Med Singap

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Introduction: This paper presents our experience with deep venous stenting in a multi-ethnic Asian cohort of patients with symptomatic Non-Thrombotic Iliac Vein Lesions (NIVL) and Post-Thrombotic Syndrome (PTS). Materials and Methods: This was a multicentre retrospective cohort study of patients who had symptomatic deep venous disease. Stent patency rate was evaluated using Duplex ultrasonography immediately post-intervention and at 3, 6 and 12 months. Clinical outcomes were evaluated using the revised Venous Clinical Severity Score (rVCSS) and Visual Analogue Scale (VAS) pain score at baseline and 3 months post-procedure. Results: 87 patients (males = 47/87 (54.0%)); median age = 62 years (IQR 55 – 70)) and 115 limbs were analysed (left = 76/115 (66.1%)). Median follow-up time was 175 (IQR 57 – 257) days. 97/115 (84.3%) had NIVLs and 55/115 (47.8%) had May-Thurner-Syndrome. 43/115 (37.4%) had Clinical, Etiology, Anatomy and Pathophysiology (CEAP) 6 disease. Primary stent patency rates were 98.2% (112/114), 97.9% (93/95), 95.7% (89/93) and 92.8% (64/69) immediately postintervention, 3, 6 and 12 months, respectively. The 6-month secondary patency rate was 99.1% (114/115). Mean rVCSS and VAS improved from 11.52 (±3.54) to 5.77 (±2.36) (P < 0.01) and 6.62 (±1.93) to 2.92 (±1.50) (P < 0.01) respectively, at 3 months. 41/43 (95.3%) venous ulcers healed over a median time of 169 days (IQR 120 – 253). Conclusions: Short term primary patency rates following deep venous stenting are excellent, with few re-interventions. Patients presented with NIVLs rather than PTS. There was excellent clinical improvement at 3 months, with a high and expedient venous ulcer healing rate. Key words: Deep vein stenting, May-Thurner Syndrome, Non-thrombotic iliac vein lesion, Post-thrombotic syndrome, Vascular patency

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“…Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) and a major cause of morbidity and healthcare costs (Williams and Dillavou 2020 ). For PTS secondary to chronic iliocaval thrombosis in which standard endovascular reconstruction techniques fail to cross the occlusion, sharp recanalization has been reported with high technical success (McDevitt et al 2019 ; Hage et al 2018 ; Ito et al 2012 ; Wadhwa et al 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Hybrid CT-angiography to facilitate lower extremity sharp venous recanalization: a novel approach to a common procedure

et al. 2020

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Background Post-thrombotic syndrome due to chronic venous occlusion is associated with high morbidity and healthcare costs. Sharp venous recanalization has been used with success when conventional techniques fail to cross the occlusion, permitting endovascular reconstruction with angioplasty and stenting. However, manipulation of a needle, especially in extra-anatomic locations, risks damage to adjacent structures, thus necessitating adequate imaging guidance. Case presentation This report describes the novel use of hybrid CT-angiography in a successful recanalization of a complex iliofemoral chronic venous occlusion, after multiple failed attempts with traditional recanalization techniques. The procedure was performed without complications, and stent patency was confirmed at three-month follow-up with patient-reported improvement in severe post-thrombotic syndrome. Conclusions This case demonstrates effective incorporation of hybrid CT-angiography to facilitate complex sharp venous recanalization for chronic lower extremity thrombosis, as an alternative to standard fluoroscopic techniques requiring multiple projections with or without cone-beam CT. Further studies are needed to understand the implications of this strategy.

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A systematic review of venous stents for iliac and venacaval occlusive disease

Cited by 66 publications

References 42 publications

Diagnostic and Technical Challenges in the Care of a Complex Patient With Post-Thrombotic Syndrome

Diagnostic and Technical Challenges in the Care of a Complex Patient With Post-Thrombotic Syndrome

Endovascular Deep Vein Stenting of Symptomatic Post-Thrombotic and Non-Thrombotic Iliac Vein Stenotic Lesions: A Multicentre Cohort Experience from Singapore

Hybrid CT-angiography to facilitate lower extremity sharp venous recanalization: a novel approach to a common procedure

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