Endovascular Treatment for Venous Diseases: Where are the Venous
                        Stents?

Schwein, Adeline; Georg, Yannick; Lejay, Anne; Nicolini, Philippe; Hartung, Olivier; Contassot, David; Thaveau, Fabien; Heim, Frédéric; Chakfé, Nabil

doi:10.14797/mdcj-14-3-208

Cited by 27 publications

(15 citation statements)

References 15 publications

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“…Indeed, despite digital subtraction angiography remaining the gold standard for aSAH, we prefer to use CTA due to its favorable accessibility, reduced invasiveness and costs compared to other radiologic modalities ( 39 ). Then, by relating morphologic venous changes, if any detected, to the clinical status of patients with aSAH, we may be able to identify favorable treatments, medical or endovascular, for improving cerebral venous outflow and functional outcomes ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Intracranial Venous Alteration in Patients With Aneurysmal Subarachnoid Hemorrhage: Protocol for the Prospective and Observational SAH Multicenter Study (SMS)

et al. 2022

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BackgroundArterial vasospasm has been ascribed as the responsible etiology of delayed cerebral infarction in patients with aneurysmal subarachnoid hemorrhage (aSAH), but other neurovascular structures may be involved. We present the protocol for a multicenter, prospective, observational study focused on analyzing morphological changes in cerebral veins of patients with aSAH.Methods and AnalysisIn a retrospective arm, we will collect head arterial and venous CT angiograms (CTA) of 50 patients with aSAH and 50 matching healthy controls at days 0–2 and 7–10, comparing morphological venous changes. A multicenter prospective observational study will follow. Patients aged ≥18 years of any gender with aSAH will be enrolled at 9 participating centers based on the predetermined eligibility criteria. A sample size of 52 aSAH patients is expected, and 52 healthy controls matched per age, gender, and comorbidities will be identified. For each patient, sequential CTA will be conducted upon admission (day 0–2), at 7–10 days, and at 14–21 days after aSAH, evaluating volumes and morphology of the cerebral deep veins and main cortical veins. One specialized image collecting center will analyze all anonymized CTA scans, performing volumetric calculation of targeted veins. Morphological venous changes over time will be evaluated using the Dice coefficient and the Jaccard index and scored using the Boeckh–Behrens system. Morphological venous changes will be correlated to clinical outcomes and compared between patients with aSAH and healthy-controls, and among groups based on surgical/endovascular treatments for aSAH.Ethics and DisseminationThis protocol has been approved by the ethics committee and institutional review board of Ethikkommission, SALK, Salzburg, Austria, and will be approved at all participating sites. The study will comply with the Declaration of Helsinki. Written informed consent will be obtained from all enrolled patients or their legal tutors. We will present our findings at academic conferences and peer-reviewed journals.Approved Protocol Version and RegistrationVersion 2, 09 June 2021.

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Section: Discussionmentioning

confidence: 99%

Intracranial Venous Alteration in Patients With Aneurysmal Subarachnoid Hemorrhage: Protocol for the Prospective and Observational SAH Multicenter Study (SMS)

et al. 2022

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“…Relative to the arterial system, the venous system is characterized by low pressure, low velocity, large volume and low resistance. 18 In addition, veins tolerate extensive dilatation without clinical rupture, and the diseased wall remains elastic despite extrinsic compression. 19 Large stent diameters are required (up to 25 mm or greater in the IVC) with increased crush resistance throughout the stent length to address the significant recoil and fibrous nature of thrombotic veins.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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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.

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“…While the etiology of arterial and venous disease is different, arterial stents have been commonly used in off-label applications in venous endovascular treatment. However, recent studies on venous stenting suggested the need for designing venous stents accounting for the specific venous pathology (Schwein et al, 2018;Bento et al, 2019). The design and manufacturing of venous stents have been overlooked and undervalued (Gordon et al, 2008) given the prevalence of venous disease and the off-label use of arterial stents.…”

Section: Introductionmentioning

confidence: 99%

“…Compared to arteries, veins are up to three times more compliant (distensible). Pathological arteries usually retain a well-defined vessel with almost no change in the vessel elasticity (Schwein et al, 2018). However, a pathological vein can undergo a fibrous retraction reducing its compliance.…”

Section: Introductionmentioning

confidence: 99%

“…Collapse is a common failure mode for stents that are placed in veins (Murphy et al, 2017). Three different buckling modes in the collapse of balloonexpandable stents are identified in (Dumoulin and Cochelin, 2000) identified and collapse in self-expanding stents has been reported in (Kim et al, 2008;Dabir et al, 2018;Schwein et al, 2018). They observed mechanical instability by applying a pinching force on the stent structure.…”

Section: Introductionmentioning

confidence: 99%

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Deformation Mechanics of Self-expanding Venous Stents: Modelling and Experiments

Hejazi¹,

Sassani²,

Gagnon³

et al. 2021

Preprint

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Deformation properties of venous stents based on braided design, chevron design, Z design, and diamond design are compared using in vitro experiments coupled with analytical and finite element modelling. Their suitability for deployment in different clinical contexts is assessed based on their deformation characteristics. Self-expanding stainless steel stents possess superior collapse resistance compared to Nitinol stents. Consequently, they may be more reliable to treat diseases like May-Thurner syndrome in which resistance against a concentrated (pinching) force applied on the stent is needed to prevent collapse. Braided design applies a larger radial pressure particularly for vessels of diameter smaller than 75% of its nominal diameter, making it suitable for a long lesion with high recoil. Z design has the least foreshortening, which aids in accurate deployment. Nitinol stents are more compliant than their stainless steel counterparts, which indicates their suitability in veins. The semi-analytical method presented can aid in rapid assessment of topology governed deformation characteristics of stents and their design optimization.

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Endovascular Treatment for Venous Diseases: Where are the Venous Stents?

Cited by 27 publications

References 15 publications

Intracranial Venous Alteration in Patients With Aneurysmal Subarachnoid Hemorrhage: Protocol for the Prospective and Observational SAH Multicenter Study (SMS)

Intracranial Venous Alteration in Patients With Aneurysmal Subarachnoid Hemorrhage: Protocol for the Prospective and Observational SAH Multicenter Study (SMS)

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

Deformation Mechanics of Self-expanding Venous Stents: Modelling and Experiments

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