Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis: a prospective study with venous Doppler follow-up at 1-year

Abstract

Functional outcome of venous stent placement for the management of acute iliofemoral deep vein thrombosis (DVT) following catheter-directed thrombolysis (CDT), remain undefined. The purpose of this study was to assess immediate and intermediate term outcomes among patients treated with venous stenting following CDT in patients with proximal lower limb DVT. Thirty consecutive patients aged between 20-70 years with proximal lower limb DVT formed the study group. The mean duration of CDT done with streptokinase was 4.5 ± 1.3 days. Patients with residual venous obstruction and/or large clot burden were treated further with venous angioplasty and/or stenting. Primary endpoint was to evaluate the safety, efficacy and patency of venous stenting in the management of incomplete result following CDT. After 12 months, post-thrombotic syndrome (PTS) was assessed clinically using Villalta scale and deep venous patency was assessed through duplex ultrasound. We studied 8 (5 female and 3 male) patients with 9 (3 left and 6 right) limb involvement and 13 stent (4 balloon expandable and 9 self expandable) placement. All patients improved clinically immediately following venous stenting. Technical success was achieved in all patients. One patient developed pulmonary embolism during course of hospital stay. One patient had stent thrombosis and PTS and another patient died due to carcinoma breast during follow-up. Deep venous stenting is an effective mode of treatment in proximal acute lower limb DVT with high late patency rate up to 1-year.

A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb

“…Recurrence of deep vein thrombosis was reported as early recurrence (within one day to one month after the procedure) in 13 studies 18–20,23,24,26,27,31,32,34,35,37,38 and as late (within 1–2 years) recurrence in 17 of included studies. 17,18,20–23,25–30,32,35,37,40 The findings of the search are summarised in Table 1.…”

“…The initial search strategy resulted in a total of 760 studies and, after applying exclusion criteria and screening title, abstract and full text, as per PRISMA guidelines, 27 studies were included in the qualitative synthesis and three articles used for quantitative synthesis (Figure 1). The studies consisted of three systematic reviews, 13,15,16 three randomised controlled trials (RCTs) [17][18][19] and 21 cohort studies (eight prospective, [20][21][22][23][24][25][26][27] 12 retrospective studies [28][29][30][31][32][33][34][35][36][37][38][39] and one study including two patient series). 40 Five studies 23,28,32,33,37 were included in whom the whole population was stented.…”

“…PTS was assessed in 26/27 studies. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40] In most of these studies, the Villalta-Prandoni scale, modified Villalta scale, 42 the VCSS 43 and the change of C in CEAP 44 classification were used. These scoring systems have been validated in different settings [45][46][47] and subsequently endorsed by the International Society on Thrombosis and Hemostasis.…”

Common femoral vein stent placement in a frozen abdomen causing acute limb ischemia

“…In general, use of venous stents is not frequent and typically indicated in situations of venous outflow obstruction related to hemodialysis access or with complicated iliofemoral deep venous thrombosis. 1 , 2 , 3 , 4 Nitinol stents (GORE Viabahn stents in particular) exhibit radial force on the vessel wall, preventing endoleak and maintaining vessel patency. Stents, however, tend to demonstrate relatively malleable and flexible features.…”

Acute Stent Migration into the Right Ventricle in a Patient with Iliac Vein Stenting

“…Postthrombotic syndromes have been treated by endovascular stents with good results. 1 2 3 Stent migration is a rare event especially into the right ventricle, where potentially serious complications including cardiac arrhythmias and heart failure may occur. To the best of our knowledge, only few cases with venous stent migration into the heart and fatal ending are reported so far and no case with open-heart surgery.…”