Long-term clinical outcomes and technical factors with the Wallstent for treatment of chronic iliofemoral venous obstruction

Gagne, Paul J.; Gagne, Nicole; Kucher, T.; Thompson, Michael; Bentley, Dana

doi:10.1016/j.jvsv.2018.07.016

Cited by 33 publications

(11 citation statements)

References 15 publications

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“…7 Advances in techniques and equipment have enabled endovascular stenting of venous structures to be employed for various indications including, but not limited to, external compression and thrombosis. 8 There is a paucity of data regarding endovascular venous reconstruction for traumatic injuries; however, adequate long-term patency of covered stent grafts in the venous limbs of arteriovenous fistulae has been demonstrated. 9 Several strategies for placement of a CVC are widely utilized.…”

Section: Discussionmentioning

confidence: 99%

Side-by-Side Stenting Repair of a Traumatic Pseudoaneurysm at a Venous Confluence

Dutmers

Soule

Bertran

et al. 2020

Vasc Endovascular Surg

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Objectives: The incidence and prevalence of iatrogenic vascular trauma in the United States is staggering. This has led to the advent and implementation of more efficient and effective vascular repair methods. Although open surgical repair may still be considered gold standard, new endovascular solutions have emerged as other viable options. When using an endovascular approach, proper stent sizing is vital to a successful repair. Methods: We present a case of a traumatic injury and pseudoaneurysm formation at the confluence of the right internal jugular and right subclavian veins during a central line placement. This iatrogenic pseudoaneurysm was treated with endovascular placement of side-by-side stents. A mathematical formula, which we have designated “Matteo’s law,” was utilized to select properly sized stent grafts to reconstruct the confluence and prevent infolding and endoleaks. Results: After deployment of kissing stents at the confluence of the right internal jugular and right subclavian veins, a venogram was performed, which demonstrated successful exclusion of the pseudoaneurysm and no endoleaks. Clinical follow-up confirms continued wide open flow through the reconstructed venous confluence at 8 months post-procedure. Conclusion: In reconstruction of a venous confluence, selection of properly sized stent grafts is paramount to preventing infolding and endoleaks. Matteo’s law states that the circumference of the native receiving vessel must equal the sum of the circumferences of both kissing stent grafts, subtracting the redundant material where the 2 stents interface.

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Section: Discussionmentioning

confidence: 99%

Side-by-Side Stenting Repair of a Traumatic Pseudoaneurysm at a Venous Confluence

Dutmers

Soule

Bertran

et al. 2020

Vasc Endovascular Surg

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“…Medium term follow-up has shown compressive effects typically at the iliac confluence area. 39 We have now stopped deploying the Wallstent™ for the last 3 years. Currently, Venovo™ (BD Medical, Arizona, USA) and Sinus Obliquus™ (Optimed, Ettlingen, Germany) are deployed as the stents of choice.…”

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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“…Moreover, this stent suffers foreshortening when deployed and post-dilated. 25 This may pose a problem when it is deployed tangential to the iliocaval confluence, where it may leave iliac lesions uncovered. Many authors report extending the Wallstent TM proximally into the IVC to avoid this complication.…”

Section: Discussionmentioning

confidence: 99%

Contralateral deep vein thrombosis after stenting across the iliocaval confluence in chronic venous disease – A systematic review

et al. 2019

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Objective Stenting of the iliac veins is increasingly considered in the presence of symptomatic obstructive chronic lesions in the iliac vein segment. However, it is often necessary to extend the stented zone into the inferior vena cava, increasing the risk of contralateral iliac vein thrombosis. This study aims to review the current literature concerning the incidence of contralateral deep vein thrombosis after stenting across the iliocaval confluence. Methods A systematic review from potentially relevant published articles reporting contralateral deep vein thrombosis after iliac venous stenting between January 2007 and February 2019 was performed. Results A total of 764 references were retrieved initially. Twelve studies reporting events of contralateral deep vein thrombosis were selected for review, with a total of 1864 patients. Contralateral deep vein thrombosis incidence varied between 0% and 15.6%. The post-interventional and follow-up anticoagulation regimens were heterogeneous between studies. The decision to maintain patients on anticoagulation and the duration of treatment was based on the presence of comorbidities, hypercoagulable states, post-thrombotic syndrome and history of recurrent deep vein thrombosis. Patients with non-thrombotic iliac vein lesions were either anticoagulated for three or six months after stenting or received no anticoagulation. Patients with post-thrombotic syndrome were anticoagulated for longer periods. Most studies (eight studies) used an oral vitamin K antagonist agent. The data on compliance with anticoagulation treatment is scarce and few references present data on whether contralateral deep vein thrombosis occurred during anticoagulation treatment. The use of antiplatelet agents in addition to the anticoagulant treatment in the follow-up period was also variable. Conclusion The incidence of contralateral deep vein thrombosis due to iliac vein jailing is not negligible and reported being as high as 15.6%. Large-scale studies on the ideal antithrombotic treatment and its impact are necessary. It is possible that patients with stent crossing the iliocaval confluence might benefit from long-term antithrombotic treatment.

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Long-term clinical outcomes and technical factors with the Wallstent for treatment of chronic iliofemoral venous obstruction

Cited by 33 publications

References 15 publications

Side-by-Side Stenting Repair of a Traumatic Pseudoaneurysm at a Venous Confluence

Side-by-Side Stenting Repair of a Traumatic Pseudoaneurysm at a Venous Confluence

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

Contralateral deep vein thrombosis after stenting across the iliocaval confluence in chronic venous disease – A systematic review

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