1
|
Barbati ME, Avgerinos ED, Baccellieri D, Doganci S, Lichtenberg M, Jalaie H. Interventional treatment for post-thrombotic chronic venous obstruction: Progress and challenges. J Vasc Surg Venous Lymphat Disord 2024; 12:101910. [PMID: 38777042 DOI: 10.1016/j.jvsv.2024.101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
Chronic venous obstruction, including nonthrombotic iliac vein lesions and post-thrombotic syndrome, presents a significant burden on patients' quality of life and health care systems. Venous recanalization and stenting have emerged as promising minimally invasive approaches, yet challenges in patient selection, procedural techniques, and long-term outcomes persist. This review synthesizes current knowledge on the interventional treatment of post-thrombotic syndrome, focusing on the evolution of endovascular techniques and stenting. Patient selection criteria, procedural details, and the characteristics of dedicated venous stents are discussed. Particular emphasis is given to the role of inflow and other anatomical considerations, along with postoperative management protocols for an optimal long-term outcome.
Collapse
Affiliation(s)
- Mohammad E Barbati
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | | | | | - Suat Doganci
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey
| | | | - Houman Jalaie
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| |
Collapse
|
2
|
Trujillo-Santos J, Demelo-Rodríguez P, Bravo de Laguna-Taboada A, Zubicoa-Ezpeleta S, Rodríguez-Morata A, Lojo-Rocamonde I, Riera-Mestre A. Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis. Semin Thromb Hemost 2024; 50:883-893. [PMID: 38733984 DOI: 10.1055/s-0044-1786755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Deep vein thrombosis (DVT) poses a complex challenge and often leads to postthrombotic syndrome (PTS), a debilitating complication. The emergence of venous stents offers a potential preventive avenue against this complication. This study aimed to provide consensus recommendations on the use of venous stent for DVT. MATERIALS AND METHODS From June to July 2023, 20 internal medicine, angiology and vascular surgery, and vascular and interventional radiology experts were involved in the Delphi process. Thirty-one recommendations, categorized into three thematic areas, were rigorously evaluated: indications for stent use, stent selection and placement, and monitoring and prevention of complications. Agreement was evaluated using a Likert scale, with consensus defined as agreement by two-thirds of the participants. RESULTS Consensus was reached for 23 (74.2%) of 31 recommendations. The agreement was centered on considerations, such as stent placement in specific acute DVT scenarios, emphasizing pivotal stent characteristics. However, there were divergences in the recommended stent length to prevent migration and stent characteristics based on iliocaval bifurcation morphology. Notably, there was no consensus on whether patients with DVT caused by a major transient risk factor need more than 3 months of anticoagulation therapy or whether aspirin should be added to anticoagulant treatment after venous stenting. CONCLUSIONS These consensus recommendations offer practical insights into optimizing venous stent use to prevent PTS in DVT patients. Addressing the critical aspects of stent selection, placement, and postprocedural care, these recommendations contribute to clinical decision-making. The identified divergences underscore the importance of consensus and thus indicate the need for further investigation.
Collapse
Affiliation(s)
- Javier Trujillo-Santos
- Internal Medicine Department, Venous Thromboembolism Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
- Universidad Católica San Antonio, Región de Murcia, Spain
- Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
- Department of Internal Medicine, Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Sanitary Research Institute Gregorio Marañón, Madrid, Spain
| | - Alexis Bravo de Laguna-Taboada
- Interventional Radiology Service, Hospital Insular de Gran Canaria, Las Palmas, Spain
- Sociedad Española de Radiología Vascular e Intervencionista
| | - Santiago Zubicoa-Ezpeleta
- Sociedad Española de Radiología Vascular e Intervencionista
- Unidad de Radiología Intervencionista, Hospital Ruber Internacional, Madrid
| | - Alejandro Rodríguez-Morata
- Servicio de Angiología y Cirugía Vascular, Hospital Quirónsalud Málaga, Málaga, Spain
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, Spain
| | - Ignacio Lojo-Rocamonde
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, Spain
- Servicio de Angiología y Cirugía Vascular, Hospital Quirónsalud A Coruña, A Coruña, Spain
| | - Antoni Riera-Mestre
- Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
- Internal Medicine Department, Venous Thromboembolism Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona, Spain)
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat (Barcelona), Spain
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Vedantham S, Weinberg I, Desai KR, Winokur R, Kolli KP, Patel S, Nelson K, Marston W, Azene E. Society of Interventional Radiology Position Statement on the Management of Chronic Iliofemoral Venous Obstruction with Endovascular Placement of Metallic Stents. J Vasc Interv Radiol 2023; 34:1643-1657.e6. [PMID: 37330211 DOI: 10.1016/j.jvir.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE To state the position of the Society of Interventional Radiology (SIR) on the endovascular management of chronic iliofemoral venous obstruction with metallic stents. MATERIALS AND METHODS A multidisciplinary writing group with expertise in treating venous disease was convened by SIR. A comprehensive literature search was conducted to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS A total of 41 studies, including randomized trials, systematic reviews and meta-analyses, prospective single-arm studies, and retrospective studies were identified. The expert writing group developed 15 recommendations on the use of endovascular stent placement. CONCLUSIONS SIR considers the use of endovascular stent placement for chronic iliofemoral venous obstruction to be likely to help selected patients, but the risks and benefits have not been fully quantified in well-designed randomized studies. SIR recommends urgent completion of such studies. In the meantime, careful patient selection and optimization of conservative therapy are recommended prior to stent placement, with attention to appropriate stent sizing and quality procedural technique. The use of multiplanar venography with intravascular ultrasound is suggested in diagnosing and characterizing obstructive iliac vein lesions and in guiding stent therapy. After stent placement, SIR recommends close patient follow-up to ensure optimal antithrombotic therapy, durable symptom response, and early identification of adverse events.
Collapse
Affiliation(s)
- Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri.
| | - Ido Weinberg
- Cardiology Division, Vascular Medicine Section, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald Winokur
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Kanti Pallav Kolli
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Kari Nelson
- Department of Radiology, Orange Coast Medical Center, Fountain Valley, California
| | - William Marston
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Ezana Azene
- Gundersen Health System, La Crosse, Wisconsin
| |
Collapse
|
4
|
Guillen K, Thony F, Del Giudice C, Goyault G, David A, Douane F, Le Bras Y, Monnin-Bares V, Heautot JF, Rousseau H, Martinelli T, Thouveny F, Barral PA, Le Pennec V, Chabrot P, Rogopoulos A, Aho-Glélé LS, Sapoval M, Rodière M, Chevallier O, Falvo N, Loffroy R. Patient-Reported Outcomes of Endovascular Treatment of Post-Thrombotic Syndrome: Ancillary Study of a French Cohort. Diagnostics (Basel) 2023; 13:2357. [PMID: 37510101 PMCID: PMC10378457 DOI: 10.3390/diagnostics13142357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Excellent outcomes of angioplasty/stenting for the post-thrombotic syndrome (PTS) have been reported, notably regarding objective criteria in the vast French SFICV cohort. Differences may exist between patient-reported and objective outcomes. We investigated this possibility by using validated scales because significative correlations are discordant in the literature between patency and patient-reported characteristics. Patient-reported outcomes seem to be a more consistent tool than radiologic patency for the diagnosis and follow-up of patients displaying PTS. We retrospectively reviewed the Villalta scale and 20-item ChronIc Venous dIsease quality-of-life Questionnaire (CIVIQ-20) scores recorded after endovascular stenting for PTS at 14 centres in France in 2009-2019. We also collected patency rates, pre-operative post-thrombotic lesion severity, and the extent of stenting. We performed multivariate analyses to identify factors independently associated with improvements in each of the two scores. The 539 patients, including 324 women and 235 men, had a mean age of 44.7 years. The mean Villalta scale improvement was 7.0 ± 4.7 (p < 0.0001) and correlated with the thrombosis sequelae grade and time from thrombosis to stenting. The CIVIQ-20 score was available for 298 patients; the mean improvement was 19.2 ± 14.8 (p < 0.0001) and correlated with bilateral stenting, single thrombosis recurrence, and single stented segment. The objective gains demonstrated in earlier work after stenting were accompanied by patient-reported improvements. The factors associated with these improvements differed between the Villalta scale and the CIVIQ-20 score. These results proved that clinical follow-up with validated scores is gainful in patients treated for PTS thanks to a mini-invasive procedure.
Collapse
Affiliation(s)
- Kévin Guillen
- Department of Interventional Radiology, CHU Dijon, 21000 Dijon, France
| | - Frédéric Thony
- Department of Interventional Radiology, CHU Grenoble, 38000 Grenoble, France
| | - Costantino Del Giudice
- Interventional Radiology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
| | - Gilles Goyault
- Department of Vascular and Oncological Interventional Radiology, Institut Cardiovasculaire de Strasbourg (ICS), Clinique Rhena, 67000 Strasbourg, France
| | - Arthur David
- Department of Interventional Radiology, CHU Nantes, 44000 Nantes, France
| | - Frédéric Douane
- Department of Interventional Radiology, CHU Nantes, 44000 Nantes, France
| | - Yann Le Bras
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Valérie Monnin-Bares
- Department of Imaging and Interventional Radiology, Montpellier University Hospital (CHU), 34000 Montpellier, France
| | | | - Hervé Rousseau
- Cardiac Imaging Centre, Toulouse University Hospital, 31000 Toulouse, France
| | - Thomas Martinelli
- Department of Medical Imaging and Radiology, Valence Hospital, 179 bd Maréchal Juin, 26953 Valence, France
| | | | - Pierre-Antoine Barral
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, 13000 Marseille, France
| | - Vincent Le Pennec
- Department of Interventional and Diagnostic Imaging, University Hospital of Caen, Avenue de la Côte de Nacre, 14033 Caen, France
| | - Pascal Chabrot
- Department of Vascular Radiology, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - André Rogopoulos
- Department of Radiology, Institut Arnault Tzanck, 06700 Saint-Laurent du Var, France
| | - Ludwig Serge Aho-Glélé
- Department of Epidemiology, Statistics and Clinical Research, Hôpital Universitaire François-Mitterrand, 21079 Dijon, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Mathieu Rodière
- Department of Interventional Radiology, CHU Grenoble, 38000 Grenoble, France
| | | | - Nicolas Falvo
- Department of Interventional Radiology, CHU Dijon, 21000 Dijon, France
| | - Romaric Loffroy
- Department of Interventional Radiology, CHU Dijon, 21000 Dijon, France
| |
Collapse
|
5
|
De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 224] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
|
6
|
Short- and Mid-Term Outcomes of Endovascular Stenting for the Treatment of Post-Thrombotic Syndrome due to Iliofemoral and Caval Occlusive Disease: A Multi-Centric Study from the French Society of Diagnostic and Interventional Cardiovascular Imaging (SFICV). Cardiovasc Intervent Radiol 2022; 45:162-171. [PMID: 34981196 DOI: 10.1007/s00270-021-03038-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/01/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the results of endovascular treatment in a large population of patients suffering from post-thrombotic syndrome (PTS) due to iliocaval occlusive disease. METHODS In this retrospective multi-center study, 698 patients treated by stenting for PTS in 15 French centers were analyzed. Primary, primary assisted, and secondary patency rates were assessed, and clinical efficacy was evaluated using Villalta and Chronic Venous Insufficiency Questionnaire in 20 questions (CIVIQ-20) scores. Outcomes were compared against pre-operative CT-based severity of the post-thrombotic lesions in the thigh (4 grades). RESULTS Technical success, defined as successful recanalization and stent deployment restoring rapid anterograde flow in the targeted vessel, was obtained in 668 (95.7%) patients with a complication rate of 3.9%. After a mean follow-up of 21.0 months, primary patency, primary assisted patency, and secondary patency were achieved in 537 (80.4%), 566 (84.7%), and 616 (92.2%) of the 668 patients, respectively. Venous patency was strongly correlated to the grade of post-thrombotic changes in the thigh, with secondary patency rates of 96.0%, 92.9%, 88.4%, and 78.9%, respectively, for grades 0 to 3 (p = .0008). The mean improvements of Villalta and CIVIQ-20 scores were 7.0 ± 4.7 points (p < .0001) and 19.1 ± 14.8 points (p < .0001), respectively. CONCLUSION Endovascular stenting as a treatment option for PTS due to chronic iliocaval venous occlusion generates a high technical success, low morbidity, high midterm patency rate, and clinical improvement. Venous patency was strongly correlated to the severity of post-thrombotic lesions in the thigh.
Collapse
|
7
|
Baccellieri D, Ardita V, Apruzzi L, Carta N, Bilman V, Melissano G, Chiesa R. Endovascular treatment of iliofemoral vein obstruction below the inguinal ligament using a new-dedicated stent: early experience from a single center. INT ANGIOL 2021; 40:187-195. [PMID: 33634688 DOI: 10.23736/s0392-9590.21.04589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to assess our experience with a new commercially available venous stent as an extension below the inguinal ligament in patients with iliofemoral venous outflow obstruction involving the common femoral vein. METHODS We treated 16 patients with iliofemoral venous outflow occlusion and post-thrombotic syndrome (PTS) (mean age: 52.5±20.2; female: 87.5%) with the Blueflow Venous Stent (plusmedica GmbH & Co. KG, Düsseldorf, Germany) between 2019 and 2020. All patients had unilateral venous disease with >50% stenosis in the iliofemoral veins. The primary endpoints assessed were technical success, primary and secondary patency rate at 1 year of follow-up, respectively. Clinical improvement was assessed with the Villalta Scale, revised venous clinical severity score (rVCSS) classification and visual analog-scale (VAS) respectively. RESULTS The technical success rate was 100%. No intraoperative and 30-days postoperative complications were documented. The primary and secondary patency rates were 80.2% and 100% respectively, at 1 year of follow-up. One in-stent occlusion and two in-stent restenosis were detected during follow-up. Stent fracture and/or migration were not observed during follow-up. A significant improvement in the Villalta Scale and rVCSS score was documented with a median score of 3 (IQR: 2-6) and 2.5 (IQR: 1-5) versus baseline at the last follow-up. A pain reduction of 18 mm on the VAS scale was documented at 1-year follow-up. CONCLUSIONS In this cohort of patients, the Blueflow Venous Stent across the inguinal ligament was safe and effective for the treatment of symptomatic iliofemoral venous disease, with a high primary patency rate at 1-year of follow-up. However, longer follow-up and larger cohorts are still needed.
Collapse
Affiliation(s)
- Domenico Baccellieri
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Vincenzo Ardita
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy -
| | - Luca Apruzzi
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Niccolò Carta
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Victor Bilman
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|