Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction

Abstract

Background-Endovenous recanalization of iliofemoral stenosis or occlusion with angioplasty and stent placement has been increasingly used to maintain long-term venous patency in patients with iliofemoral venous outflow obstruction. The purpose of this systematic review and meta-analysis was to determine safety and effectiveness of venous stent placement in patients with iliofemoral venous outflow obstruction. Methods and Results-We searched MEDLINE and EMBASE for studies evaluating safety or effectiveness of stent placement in patients with iliofemoral venous outflow obstruction. Data were extracted by disease pathogenesis: nonthrombotic, acute thrombotic, or chronic post-thrombotic. Main outcomes included technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years. A total of 37 studies reporting 45 treatment effects (nonthrombotic, 8; acute thrombotic, 19; and chronic post-thrombotic, 18) from 2869 patients (nonthrombotic, 1122; acute thrombotic, 629; and chronic post-thrombotic, 1118) were included. Technical success rates were comparable among groups, ranging from 94% to 96%. Complication rates ranged from 0.3% to 1.1% among groups for major bleeding, from 0.2% to 0.9% for pulmonary embolism, from 0.1% to 0.7% for periprocedural mortality, and from 1.0% to 6.8% for early thrombosis. Patient symptom relief data were reported inconsistently. At 1 year, primary and secondary patency were 96% and 99% for nonthrombotic, 87% and 89% for acute thrombotic, and 79% and 94% for chronic post-thrombotic. Conclusions-Stent Methods Literature SearchThis study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. 9 We searched MEDLINE and EMBASE for randomized or nonrandomized controlled studies and prospective or retrospective case series of stent placement for treatment of iliofemoral venous outflow obstruction by using a combination of relevant keywords. The details of the MEDLINE search strategy are listed in Table I in the Data Supplement. The syntax for EMBASE was similar, but adapted as necessary. In addition, manual searches were conducted using the Directory of Open Access Journals, Google Scholar, and the reference lists of included papers and relevant meta-analyses. No date restrictions were applied to the searches. The final search was conducted March 15, 2015. Study SelectionTwo researchers independently selected studies for inclusion in the review. Disagreements were resolved by consensus. Titles and abstracts were initially screened to exclude review articles, commentaries, letters, case reports, and obviously irrelevant studies. Full texts of the remaining articles were retrieved and reviewed. Main inclusion criteria included studies with (1) primary diagnosis of obstructive lesions of the common femoral vein, external iliac vein, and the common iliac vein, (2) stent placement in the common femoral vein, external iliac vein, common iliac vein, and the inferior vena cava, (3) outcomes reporte...

Complex interventional iliocaval recanalization due to plasmacytoma and cystic echinococcosis

“…Furthermore, it is important to point out that the performers' degree of experience is elementary for a successful recanalization and a long-term patency rate, especially when treating complex cases such as these, requiring stenting of the iliocaval confl uence as in our second case [15,16]. Beside possible re-stenosis and persistence of symptoms, invasive treatment harbours a low risk of major bleeding from 0.3 -1.1 %, vessel perforation, compartment syndrome, pulmonary embolism from 0.2 % -0.9 %, periprocedural mortality from 0.1 % -0.7 %, stent fracture, and stent dislocation as well as early thrombosis from 1.0 % -6.8 % [3,11,14,17,18]. In addition, it is important to note that the radiation exposure increases with the complexity of the intervention, particularly in young patients undergoing interventions of the inferior vena cava plus both iliac veins, radiation exposures needs to be considered.…”

“…Recently published data by Stuck et al underline the excellent sustained patency; primary and secondary patency rates were 92% and 100% at six months [13]. A meta-analysis of Razavi et al reported a high technical success rate, depending on the cause of obstruction: For a total of 2,869 patients out of 37 studies, 12 months primary and secondary patency for chronic post-thrombotic disease pathogenesis was 79 % and 94 %, respectively [3].…”

“…This not only includes the interventional treatment of acute deep vein thrombosis and pulmonary embolism [1,2], but also the recanalization of chronic venous occlusions [3]. About half of all patients with a thrombosis of the common femoral or iliac vein are likely to develop a PTS [4].…”

Beneficial Effect of Endovascular Treatment on Villalta Score in Japanese Patients With Chronic Iliofemoral Venous Thrombosis and Post-Thrombotic Syndrome

“…11 In our study, 7 of 9 patients with procedural success (78%) were treated only with ballooning, whereas the remaining 2 patients (12%) received a stent and showed vein patency at 6 months post-intervention. Neglen et al reported 5-year stent patency rates of 67%.…”

Recapitulation and Synthesis

“…In this journal alone, for example, 13 meta-analyses were published between 2013 and 2015, and 7 of the 112 original articles that appeared in 2015 fell into this category. [1][2][3][4][5][6][7] Given the proliferation of such studies, in this journal and in the field more broadly, it seems an opportune moment to reflect briefly on their place in the evolving literature on structural interventions.…”