Risk factors and classification of reintervention following deep venous stenting for acute iliofemoral deep vein thrombosis

Pouncey, Anna; Kahn, Taha; RI, Morris; Saha, Prakash; Thulasidasan, Narayanan; SA, Black

doi:10.1016/j.jvsv.2022.03.006

Cited by 11 publications

(3 citation statements)

References 32 publications

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“…Ensuring proper prescription and adherence to anticoagulation is crucial for upholding vessel patency (28). A retrospective study by Pouncey et al (29) indicated that a significant number of patients required reintervention due to factors that could potentially be prevented. Out of 143 limbs (133 patients), 48 (33.6%) necessitated reintervention, with 25 experiencing reocclusion (17.4%).…”

Section: Insufficient Drug Therapy/thrombophilia/ Compliancementioning

confidence: 99%

Cases of Venous Stent Failure in Lower Extremities

Kim,

Labropoulos

2023

Ann Phlebology

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Iliofemoral venous outflow obstruction, arising from nonthrombotic iliac vein lesions (NIVLs) or post-thrombotic disease (PTs), is a frequent culprit behind chronic venous signs and symptoms. In response, the adoption of deep venous stenting has gained traction, demonstrating commendable technical success and acceptable complication rates in the management of both acute and chronic venous obstruction. However, the focus on venous stent failure has intensified due to concerns related to in-stent restenosis or thrombosis. Such complications elevate the risks of symptom recurrence and thrombosis relapse, necessitating a judicious approach. The identified contributors to venous stent failure encompass multifaceted factors, including insufficient coverage of the affected area, inadequate vein inflow, inappropriate stent sizing, suboptimal drug therapy, patient non-compliance, stent migration, or fracture. This paper provides a comprehensive exploration of these factors associated with venous stent failure, shedding light on the complexities surrounding the efficacy and longevity of deep venous stenting in the context of iliofemoral venous outflow obstruction.

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Section: Insufficient Drug Therapy/thrombophilia/ Compliancementioning

confidence: 99%

Cases of Venous Stent Failure in Lower Extremities

Kim,

Labropoulos

2023

Ann Phlebology

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“…According to recently reported studies, larger stent diameter and antiplatelet therapy were associated with improved stent patency, whereas multiple stents and irregular compression stocking wearing were predictors of in-stent obstruction (15)(16)(17). In addition, the relationship between stenting across the inguinal ligament and stent patency is still controversial (18)(19)(20). Another study on iliocaval stenting found no clear effect of the duration of anticoagulant and antiplatelet treatment on the patency of venous stents (15).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for stent occlusion after catheter-directed thrombolysis and iliac vein stenting in the treatment of May-Thurner syndrome with iliofemoral deep vein thrombosis: a retrospective cohort study

Kim¹,

Park²,

Hong³

et al. 2022

Quant Imaging Med Surg

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Background: This study aimed to identify the risk factors for stent occlusion in patients with iliofemoral deep vein thrombosis (DVT) secondary to May-Thurner syndrome (MTS) who underwent catheter-directed thrombolysis (CDT) and iliac vein stenting. Methods: A retrospective analysis was performed on 44 patients who underwent CDT and iliac vein stenting for MTS with iliofemoral DVT between October 2001 and March 2018. MTS was diagnosed based on extrinsic compression of the left common iliac vein (CIV) by the overlying right common iliac artery (CIA) on computed tomography (CT). Clinical records of the study population were reviewed to collect baseline data, procedural characteristics, and outcomes. Final venograms showing diffuse and irregular wall thickening in the iliofemoral vein were considered to indicate a chronic post-thrombotic lesion. The stent position was categorized as follows: confluence coverage without touching the contralateral inferior vena cava (IVC) wall, IVC extension contacting the contralateral IVC wall, or distal to the iliocaval junction.Stent patency was assessed using duplex ultrasonography. Risk factors for stent occlusion were assessed using univariate and multivariate Cox proportional hazard models. Results:The median duplex ultrasound follow-up period was 25 months (range, 1-196 months).The overall cumulative patency rate at 12 months was 70.0%. In the univariate Cox regression, factors significantly associated with stent occlusion included symptom duration >2 weeks before CDT, partial thrombolysis (50-99% of thrombus removal), chronic post-thrombotic lesions, and stent position.Multivariate Cox regression showed that chronic post-thrombotic lesions [hazard ratio (HR) =7.15; 95% confidence interval (CI): 1.32-38.81; P=0.023] and a stent distal to the iliocaval junction (HR =5.59; 95% CI: 1.46-21.38; P=0.012) were significantly associated with stent occlusion.Conclusions: Chronic post-thrombotic lesion and a stent distal to the iliocaval junction were important risk factors for stent occlusion in patients who underwent CDT and iliac vein stenting.

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“…This ultimately results in long-term presence of thrombus and subsequent vein wall remodeling. 12 Extrapolating to clinical results in the management of DVT the principles of inflow and outflow must be central to outcomes. The ability to clear the inflow and outflow should lead to reduced events of recurrent DVT.…”

mentioning

confidence: 99%