Clinical outcomes and overview of dedicated venous stents for management of chronic iliocaval and femoral deep venous disease

Abstract

Objectives Venous stenting of the lower extremities has grown in popularity and is now considered a key component of the primary treatment strategy for the management of pathologically obstructive or stenotic lesions of the deep venous system. This review aims to provide an overview of the role of venous stenting in the management of chronic conditions affecting the deep venous system of the lower limbs. Methods An overview of venous stents design and current role of stenting procedure in individuals presenting with Chronic Venous Insufficiency (CVI) and presenting the current trials of dedicated venous stenting in management of chronic deep venous lesions. This review provides a focused insight on venous stent design, physical properties and the available dedicated venous stents selected studies with their related patency outcome based on selective literature search of the PubMed database and Cochrane library. Conclusions Dedicated venous stent technology is advancing at a rapid pace alongside the increased undertaking of endovascular deep venous stent reconstruction in the management of iliocaval vein pathologies. The ideal design(s) for venous stents remain unknown, although it is hoped that the presence of new dedicated venous stents in clinical practice will allow the generation of experience and data to advance our understanding in this area.

A comprehensive study on venous endovascular management and stenting in deep veins occlusion and stenosis: A review study

“…The venous system carries a larger volume of blood with lower pressure and velocity compared to the arterial system. Consequently, venous walls have higher resistance to dilation and are more flexible to external compressions [ 18 ].…”

“…Additionally, the stent should have a high radial force to maintain its diameter, especially in veins that are exposed to compressions [ 18 ]. The radial force is defined as the external force of the stent or the strength of the stent when compressed to 10 % of the original diameter [ 26 ].…”

“…Moreover, a study by Cheng et al [ 61 ] reported that the point of maximum flexion of the iliac venous system during hip flexion is inferior to the inguinal ligament, and the common femoral vein is several centimeters inferior to the inguinal ligament. So extending stents below this level does not significantly affect patency rates [ 18 ]. Factors influencing stent selection in the iliocaval venous system …”

A systematic review of reported outcomes in people with lower limb chronic venous insufficiency of the deep veins

“…Recently, novel treatments such as venous stenting and minimally invasive valvular procedures have been developed and tested in clinical trials. [12][13][14] While these innovations appear encouraging, considerable heterogeneity in the outcomes reported have hindered comparison of these trials and posed challenges to evidence synthesis. 10, 12 Concerns have also been raised that the outcomes currently reported fail to reflect the priorities of under-represented stakeholders such as patients and their carers.…”

Re: Clinical outcomes and overview of dedicated venous stents for management of chronic iliocaval and femoral deep venous disease

“…To the Editor, I wanted to congratulate Taha MA et al 1 for their excellent and comprehensive review on dedicated venous stents in the management of chronic iliocaval and femoral deep venous disease. A few additional points that maybe of interest to the readers are listed below:…”