1
|
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
|
2
|
Yan Y, Barbati ME, Avgerinos ED, Doganci S, Lichtenberg M, Jalaie H. Elevation of cardiac enzymes and B-type natriuretic peptides following venous recanalization and stenting in chronic venous obstruction. Phlebology 2024:2683555241261321. [PMID: 38862920 DOI: 10.1177/02683555241261321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND B-type natriuretic peptides (BNP) and cardiac enzymes are both recognized biomarkers of heart health. Many studies have reported that using these indicators can assess cardiac condition and predict prognosis of patients undergoing surgery. Currently little is known on the effect of increased cardiac input after venous recanalization on cardiac physiology in patients with chronic venous obstruction (CVO). OBJECTIVES The aim of this study was to explore the effect of iliocaval recanalization and stenting on cardiac biomarkers in patients with CVO. METHODS This was a prospective study involving 60 patients in a single unit. Blood tests were collected 1 day before and 1 day after venous intervention. Three groups as group 1: patients with iliofemoral post-thrombotic syndrome (PTS) but without involvement of inferior vena cava (IVC) (n = 33); group 2: patients with iliofemoral PTS and involvement of IVC (n = 19) and group 3: patients with non-thrombotic vein lesion (NIVL) (n = 8) were compared based on cardiac biomarker levels. RESULTS Median concentration of post-operative BNP (259.60 pg/mL) was greater than preoperative levels (49.80 pg/mL) [interquartile range (IQR), 147.15/414.68 versus 29.85/82.88; p < 0.001]. The levels of CK-MB [preop: 3 U/l (IQR, 1.40/11.00) versus postop: 14 U/l (IQR, 12/17), p < 0.001] and troponin T [preop: 3.00 pg/mL (IQR, 3.00/5.25) versus postop: level of 6 pg/mL (IQR, 3.00/9.50), p < 0.001]. Post-procedure increases in cardiac enzymes showed significant differences in BNP (p = 0.023) and troponin T (p = 0.007) across the three groups, while CK-MB levels were not significantly different (p > 0.05). Intergroup comparisons of postoperative BNP: group 1 versus group 2 (p = 0.013), group 2 versus group 3 (p = 0.029), group 1 versus group 3 (p = 0.834); and postoperative troponin T: group 1 versus group 2 (p = 0.018), group 2 versus group 3 (p = 0.002), group 1 versus group 3 (p = 0.282). According to multiple linear regression analysis, length of stenting and level of preoperative BNP were independent determinants of postoperative BNP levels (p < 0.05), and preoperative troponin T affected postoperative troponin T independently (p < 0.05). CONCLUSIONS Troponin T, CK-MB and BNP seem to increase after venous recanalization and stent implantation, the elevation being more prominent for longer lesions.
Collapse
Affiliation(s)
- Yan Yan
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Mohammad E Barbati
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Efthymios D Avgerinos
- Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece
| | - 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
|
3
|
Salimi J, Chinisaz F, Yazdi SAM. A comprehensive study on venous endovascular management and stenting in deep veins occlusion and stenosis: A review study. Surg Open Sci 2024; 19:131-140. [PMID: 38690401 PMCID: PMC11058076 DOI: 10.1016/j.sopen.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
Background Patients with deep venous disease can be classified into two distinct categories: those with disease resulting from known deep vein thrombosis (DVT), which may subsequently lead to post-thrombotic syndrome (PTS), and those with disease caused by compressive factors or non-thrombotic iliac vein lesions (NIVL). The major factor causing the symptoms in patients with PTS and NIVL is venous hypertension which happens due to venous stenosis or venous obstruction. Nowadays Venous stenting offers a noninvasive approach for treatment of NIVL and PTS demonstrating high patency rate. Methods We comprehensively reviewed relevant published papers from 2008 to 2023 that surveyed various influencing factors including the site of occlusion and etiology of occlusions, proper diagnostic imaging, ideal characteristics of venous stents, different dedicated venous stents, pre-operative, concomitant, and post-operative interventions and factors that challenge stenting in both PTS and NIVL patients. The papers were identified by searching the keywords "venous stenting", "PTS", "NIVL", "occlusion", and "stenosis" in PubMed central library MEDLINE and Google Scholar. Results Patency rates, post-stent complications, and relevant data according to the patient's quality of life were included and analyzed from 476 identified studies. There is no validated protocol and guideline for using stents in patients with PTS and NIVL. Conclusion As there is no validated protocol and guideline for using stents in patients with PTS and NIVL, our study may provide comprehensive information to assist researchers interested in writing the protocol and give them insight.
Collapse
Affiliation(s)
- Javad Salimi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Chinisaz
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
4
|
Peng M, Nie C, Chen J, Li C, Huang W. An Evaluation of the Duration of Oral Anticoagulant Use Among Patients Undergoing Endovascular Treatment of Nonthrombotic Iliac Vein Lesions. Ann Vasc Surg 2024; 100:110-119. [PMID: 38128691 DOI: 10.1016/j.avsg.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND This study aimed to compare clinical outcomes associated with the duration of postoperative direct oral anticoagulant (DOACs) therapy in patients with nonthrombotic iliac vein lesions. METHODS We retrospectively analyzed 176 consecutive patients who underwent stenting for nonthrombotic iliac vein lesions between March 2018 and December 2021. In total, 99 and 77 patients were discharged on a 3-month and >3-month regimen of DOAC therapy, respectively. The primary cumulative endpoint was a composite of thrombotic complications, bleeding complications, primary patency, primary-assisted patency, and secondary patency within 1 year. RESULTS Patients undergoing 3-month and >3-month DOAC therapy were similar in age, sex, lesion site, symptoms, and average stent diameter and length. Upon multivariate analysis, the primary cumulative endpoint did not differ between the 2 groups (hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.42-3.30; P = 0.76). Moreover, the primary patency at 1 year did not differ between the groups (HR: 1.50; 95% CI: 0.14-16.54; P = 0.74). Furthermore, there were no discernible differences in the secondary endpoints of bleeding complications (HR: 0.66; 95% CI: 0.22-1.96; P = 0.45) or thrombotic complications (HR: 1.79; 95% CI: 0.55-5.80; P = 0.34) between the groups. CONCLUSIONS The 3-month regimen of DOAC therapy showed a similar risk of postoperative thrombosis and bleeding when compared to longer DOAC therapy durations over the course of 1 year following endovascular intervention. This could be a preferred option for patients with a higher estimated bleeding risk after venous stenting.
Collapse
Affiliation(s)
- Minyong Peng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengli Nie
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangwei Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
5
|
Shekarchian S, Van Laanen J, Esmaeil Barbati M, Vleugels MJ, Nelemans P, Razavi MK, Mees B, Jacobs MJ, Jalaie H. Editor's Choice - Quality of Life after Stenting for Iliofemoral Venous Obstruction: A Randomised Controlled Trial with One Year Follow Up. Eur J Vasc Endovasc Surg 2023; 66:678-685. [PMID: 37517579 DOI: 10.1016/j.ejvs.2023.07.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/13/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Deep venous obstruction (DVO) is a great burden on the healthcare system and patients' quality of life (QoL). Case series show stenting is safe and effective, however most studies lack control groups and QoL changes have not been compared with conventional treatment. The aim was to assess the difference in QoL changes from baseline to 12 months between stent and conventionally treated patients with DVO. METHODS Subjects > 18 years old with DVO due to post-thrombotic (PTS) or non-thrombotic iliac vein lesions (NIVLs) in a tertiary hospital were prospectively randomised to best medical therapy (BMT) or stent placement with BMT in a ratio 2:1, stratified for PTS or NIVL. The primary outcome was the between group difference in VEINES-QoL scores change from baseline to 12 months after treatment. Secondary outcomes included the difference in score changes for EuroQoL 5-Dimension 5 Level (EQ-5D-5L), Pain Disability Index (PDI), Venous Clinical Severity Score (VCSS), and the Villalta score. RESULTS After three years, the inclusion rate dropped to almost zero, therefore the study had to be stopped. Sixty-three patients were randomised to either the stent (n = 42) or control group (n = 21). Overall, 50 patients had available data for primary outcome analysis. The adjusted mean difference between 12 month scores for VEINES-QoL and VEINES-Sym was 8.07 (95% CI 3.04 - 13.09) and 5.99 (95% CI 0.75 - 11.24) (p = .026), respectively, in favour of the stent group. The differences were significant, but a pre-defined meaningful 14 point improvement in QoL was not reached. The mean difference between 12 month scores for VCSS was -2.93 (95% CI -5.71 - 0.16, p = .040), -11.83 (95% CI -20.81 - 2.86, p = .011) for PDI, 0.015 (95% CI -0.12 - 0.15, p = .82) for the EQ-5D index, and -2.99 (95% CI -7.28 - 1.30, p = .17) for the Villalta score. CONCLUSION Symptomatic patients with DVO who received dedicated venous stents had significantly higher VEINES-QoL/Sym scores at 12 months compared with the control group, but the between group difference was lower than the pre-specified clinically relevant QoL difference of at least 14 points. STUDY REGISTRATION NUMBER NCT03026049.
Collapse
Affiliation(s)
- Soroosh Shekarchian
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jorinde Van Laanen
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Marie-José Vleugels
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patty Nelemans
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | | | - Barend Mees
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michael J Jacobs
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; European Vascular Centre Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Houman Jalaie
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; European Vascular Centre Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany.
| |
Collapse
|
6
|
Bakas JM, Moelker A, van Montfrans C, Kruip M, Verhagen HJM, van Rijn MJE. Long Term Follow Up, Causes for Re-intervention, and Consequences for Surveillance After Stenting for Proximal Deep Vein Obstruction. Eur J Vasc Endovasc Surg 2023; 66:389-396. [PMID: 37385366 DOI: 10.1016/j.ejvs.2023.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/19/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Venous stenting is performed increasingly for acute deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS) with good short term patency results, but long term data are scarce. The purpose of this study was to evaluate long term outcome of stenting for acute DVT and PTS and to study causes of re-intervention. METHODS All patients stented for acute DVT and PTS between May 2006 and November 2021 were included retrospectively in this single centre cohort study. Patency was studied by duplex ultrasound (DUS) or computed tomography. The primary endpoint was stent patency. Re-intervention free survival was calculated using Kaplan-Meier methods. Secondary endpoints were causes of re-intervention, using the Pouncey classification system (2022). Binary logistic regression was used to calculate odds ratios for predictors of re-intervention. RESULTS A total of 114 patients were included, with 129 limbs involved (acute DVT n = 53; 41%), PTS n = 76; 59%). Median follow up was 2.3 years (interquartile range [IQR] 2.3) for acute DVT and 5.2 years (IQR 7.1) for PTS. Primary patency, secondary patency, and permanent occlusion were 73.5%, 98.1%, and 1.9% for acute DVT, and 63.2%, 92.1%, and 7.9% for PTS limbs. Overall, 41 limbs underwent at least one re-intervention: 14 in the acute DVT group and 27 for PTS. Most re-interventions (82.9%) were performed within the first year after stenting. Missed inflow, insufficient flow, and thrombosis despite anticoagulation were the most common causes of re-intervention. The strongest predictor for re-intervention for PTS was inflow disease (odds ratio 3.57, 95% confidence interval 1.26 - 10.13, p= .017). CONCLUSION Long term patency of deep venous stenting is good. Re-interventions are typically performed in the first year and are potentially preventable by improving the procedure and patient selection. Since secondary patency rates are excellent, selected patients may be considered for discharge from long term surveillance.
Collapse
Affiliation(s)
- Jay M Bakas
- Department of Vascular and Endovascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Marieke Kruip
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Vascular and Endovascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marie Josee E van Rijn
- Department of Vascular and Endovascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Xiang Q, Tian J, Zhu X, He C, Huang S. Case report: Iliac vein rupture during endovascular stenting in radiation-induced iliac venous stenosis. Front Oncol 2023; 13:1166812. [PMID: 37274270 PMCID: PMC10235677 DOI: 10.3389/fonc.2023.1166812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Only a few case reports in the medical literature describe radiation-induced iliac vein stenosis and endovascular therapy. We present a case of left external iliac vein stenosis resulting from radiotherapy for cervical cancer in which the iliac vein ruptured during the standard iliac vein stenting procedure. The emergency condition was resolved with the implantation of a covered stent and resuscitation with crystalloid and blood transfusion. The patient recovered without additional complications and was discharged eight days after endovascular therapy. At the six-month follow-up, the left lower limb edema had resolved completely, and the deep vein remained patent. This case might raise concerns regarding the potential risk of treating radiation-induced iliac venous stenosis, which may differ from that of a patient without a history of radiation therapy. Iliac vein rupture, iliac vein stenting, radiation-induced venous stenosis, case report.
Collapse
Affiliation(s)
- Qilin Xiang
- Department of Vascular Surgery, Chengdu DongLi Hospital, Chengdu, Sichuan, China
| | - Jinbo Tian
- Department of Vascular Surgery, Chengdu DongLi Hospital, Chengdu, Sichuan, China
| | - Xiaoling Zhu
- Department of Vascular Surgery, Chengdu DongLi Hospital, Chengdu, Sichuan, China
| | - Chunshui He
- Department of Vascular Surgery, Chengdu DongLi Hospital, Chengdu, Sichuan, China
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shan Huang
- Department of oncology, Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
| |
Collapse
|
8
|
Morris RI, Jackson N, Smith A, Black SA. A Systematic Review of the Safety and Efficacy of Inferior Vena Cava Stenting. Eur J Vasc Endovasc Surg 2023; 65:298-308. [PMID: 36334902 DOI: 10.1016/j.ejvs.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/05/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Inferior vena cava (IVC) stenting may provide benefit to patients with symptomatic obstruction; however, there are no devices currently licensed for use in the IVC and systematic reviews on the topic are lacking. The aim of this study was to carry out a systematic review of the literature and meta-analysis to investigate the safety and efficacy of IVC stenting in all adult patient groups. DATA SOURCES The Medline and Embase databases were searched for studies reporting outcomes for safety and effectiveness of IVC stenting for any indication in series of 10 or more patients. REVIEW METHODS A systematic review of the literature was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Thirty-three studies were included describing 1 575 patients. Indications for stenting were malignant IVC syndrome (229 patients), thrombotic disease (807 patients), Budd-Chiari syndrome (501 patients), and IVC stenosis post liver transplantation (47 patients). The male:female ratio was 2:1 and the median age ranged from 30 to 61 years. The studies included were not suitable for formal meta-analysis as 30/33 were single centre retrospective studies with no control groups and there was considerable inconsistency in outcome reporting. There was significant risk of bias in 94% of studies. Median reported technical success was 100% (range 78 - 100%), primary patency was 75% (38 - 98%), and secondary patency was 91.5% (77 - 100%). Major complications were pulmonary embolism (three cases), stent migration (12 cases), and major bleeding (15 cases), and there were three deaths in the immediate post-operative period. Most studies reported improvement in clinical symptoms but formal reporting tools were not used consistently. CONCLUSION The evidence base for IVC stenting consists of predominantly single centre, retrospective, observational studies that have a high risk of bias. Nonetheless the procedure appears safe with few major adverse events, and studies that reported clinical outcomes demonstrate improvement in symptoms and quality of life. Randomised controlled trials and prospective registry based studies with larger patient numbers and standardised outcome are required to improve the evidence base for this procedure.
Collapse
Affiliation(s)
- Rachael I Morris
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
| | | | - Alberto Smith
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Stephen A Black
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
| |
Collapse
|
9
|
Lui DH, Williamson HM, Hamilton G, Drebes A, Davies N, Lim CS. Lower Limb Weakness due to Spinal Venous Congestion in Chronic Inferior Vena Cava Occlusion: A Case Report. Vasc Endovascular Surg 2023; 57:175-181. [PMID: 36189730 DOI: 10.1177/15385744221131202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CASE REPORT A 31 year-old male presented with a long history of reduced sensation and motor function in his lower limbs upon waking every morning, lasting 30-50 minutes during which he was unable to ambulate. He was involved in a severe road traffic accident as a child, and was born prematurely requiring prolonged neonatal hospitalisation. Both duplex ultrasonography and magnetic resonance venography identified an occlusion of the IVC, with patent common femoral and iliac veins draining into large spinal collaterals. No other cause was identified for his symptoms. After appropriate multidisciplinary team discussion and patient counselling, the patient proceeded to have endovenous recanalization of his IVC and common iliac veins with dedicated venous stents. Post-operatively, the patient reported an immediate resolution of neurological symptoms, with an improvement in quality of life questionnaire scores and with stent patency at 9-month follow up. CONCLUSION IVC occlusion with symptomatic spinal venous congestion is a rare condition which may be successfully treated with endovascular iliocaval recanalization, although long-term outcomes of this treatment are still unknown.
Collapse
Affiliation(s)
- Dennis H Lui
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
| | | | - George Hamilton
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
| | - Anja Drebes
- Department of Haematology, 4965Royal Free Hospital, UK
| | - Neil Davies
- Department of Interventional Radiology, 4965Royal Free Hospital, UK
| | - Chung S Lim
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
| |
Collapse
|
10
|
Sen I, Chait J, Cifuentes S, Kalra M. Symptomatic fractured iliac venous stent in a young patient. J Vasc Surg Cases Innov Tech 2022; 8:701-702. [PMID: 36388147 PMCID: PMC9664141 DOI: 10.1016/j.jvscit.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
|
11
|
Law MKK, Chin HK, Chu CY, Tang YKK, Leung KW, Kan WK. Iliocaval stenting for May–Thurner syndrome: Initial experience. J Clin Imaging Sci 2022; 12:52. [PMID: 36128351 PMCID: PMC9479514 DOI: 10.25259/jcis_82_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 11/05/2022] Open
Abstract
The aim of this report is to describe our experience in endovascular treatment of May–Thurner syndrome. We report three cases of iliocaval stenosis treated endovascularly at our institution. We included three patients age range from 41 to 85 years with two presenting with acute deep vein thrombosis and associated limb swelling and one with chronic lower limb symptoms. We reviewed the technical success, complications, and stent patency on follow-up, latter was monitored be serial imaging. The three cases of iliocaval stenosis were treated with endovascular stenting with follow-up imaging follow-up period ranged from 6 to 13 months (mean 5.6 months) with two out of the three cases maintaining stent patency. One case was complicated by intraprocedural reopening of previously venous bleed. Clinical symptoms resolved with no recurrence in two out of three cases. One case experienced symptomatic in-stent thrombosis following endovascular treatment. Endovascular treatment of iliocaval stenosis appears effective in immediate technical success. Periprocedural attention to anticoagulation and stent position are important in preventing in-stent restenosis.
Collapse
Affiliation(s)
- Matthew Ka Ki Law
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong,
| | - Hoi Kevin Chin
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong,
| | - Chi Yeung Chu
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong,
| | - Yip Kan Kendrick Tang
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong,
| | - Kam Wing Leung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong,
| | - Wai Kuen Kan
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong,
| |
Collapse
|
12
|
Antipova CG, Parunova YM, Vishnevskaya MV, Krasheninnikov SV, Lukanina KI, Grigoriev TE, Chvalun SN, Gotovtsev PM. Biomechanical behaviour of PEDOT:PSS-based hydrogels as an electrode for stent integrated enzyme biofuel cells. Heliyon 2022; 8:e09218. [PMID: 35368535 PMCID: PMC8971615 DOI: 10.1016/j.heliyon.2022.e09218] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/31/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022] Open
Abstract
The possibility of creating a biofuel cell based on a metal stent was shown in this study. Given the existing stent implantation approaches, the integration of a biofuel cell into a stent naturally entails capacity for biofuel cells to be installed into a human body. As a counter electrode, a hydrogel based on iota-carrageenan, polyvinyl alcohol, and PEDOT:PSS, with an immobilized glucose oxidase enzyme, was proposed. Tension tests demonstrated that the hydrogel mechanical behavior resembles that of a bovine's vein. To obtain an analytical description, the deformation curves were fitted using Gent and Ogden models, prompting the fitting parameters which can be useful in further investigations. During cyclic biaxial studies the samples strength was shown to decreases insignificantly in the first 50 cycles and, further, remains stable up to more than 100 cycles. The biofuel cell was designed with the PEDOT:PSS based material as an anode and a Co–Cr self-expanding stent as a cathode. The maximum biofuel cell power density with a glucose concentration of 5 mM was 7.87 × 10−5 W in phosphate buffer and 3.98 × 10−5 W in blood mimicking buffer. Thus, the biofuel cell integration in the self-expanding stent was demonstrated.
Collapse
Affiliation(s)
- Christina G Antipova
- National Research Centre "Kurchatov Institute", Department of Nanobiomaterials and Structures, Akademika Kurchatova pl., 1, 123182, Moscow, Russia
| | - Yulia M Parunova
- National Research Centre "Kurchatov Institute", Biotechnology and Bioenergy Department, Akademika Kurchatova pl., 1, 123182, Moscow, Russia
| | - Maria V Vishnevskaya
- National Research Centre "Kurchatov Institute", Biotechnology and Bioenergy Department, Akademika Kurchatova pl., 1, 123182, Moscow, Russia
| | - Sergey V Krasheninnikov
- National Research Centre "Kurchatov Institute", Department of Nanobiomaterials and Structures, Akademika Kurchatova pl., 1, 123182, Moscow, Russia
| | - Ksenia I Lukanina
- National Research Centre "Kurchatov Institute", Department of Nanobiomaterials and Structures, Akademika Kurchatova pl., 1, 123182, Moscow, Russia
| | - Timofei E Grigoriev
- National Research Centre "Kurchatov Institute", Department of Nanobiomaterials and Structures, Akademika Kurchatova pl., 1, 123182, Moscow, Russia.,Moscow Institute of Physics and Technology (National Research University), 9 Institutskiy per., Dolgoprudny, Moscow Region, 141701, Russia
| | - Sergei N Chvalun
- National Research Centre "Kurchatov Institute", Department of Nanobiomaterials and Structures, Akademika Kurchatova pl., 1, 123182, Moscow, Russia
| | - Pavel M Gotovtsev
- National Research Centre "Kurchatov Institute", Biotechnology and Bioenergy Department, Akademika Kurchatova pl., 1, 123182, Moscow, Russia.,Moscow Institute of Physics and Technology (National Research University), 9 Institutskiy per., Dolgoprudny, Moscow Region, 141701, Russia
| |
Collapse
|
13
|
Murphy E, Gibson K, Sapoval M, Dexter DJ, Kolluri R, Razavi M, Black S. Pivotal Study Evaluating the Safety and Effectiveness of the Abre Venous Self-Expanding Stent System in Patients With Symptomatic Iliofemoral Venous Outflow Obstruction. Circ Cardiovasc Interv 2022; 15:e010960. [PMID: 35105153 PMCID: PMC8843393 DOI: 10.1161/circinterventions.121.010960] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Iliofemoral venous obstruction is recognized with increasing frequency as the underlying cause of lower extremity symptoms including edema, pain, skin changes, and, in advanced cases, ulceration. This study sought to evaluate the safety and effectiveness of the Abre venous self-expanding stent system for the treatment of symptomatic iliofemoral venous outflow obstruction. Methods: The ABRE Study (A Multi-Center, Non-Randomized Study to Evaluate the Safety and Effectiveness of the Abre Venous Self-Expanding Stent System in Patients With Symptomatic Iliofemoral Venous Outflow Obstruction) is a single-arm, multicenter, prospective study that included 200 subjects from 24 global sites. The primary end points were 12-month primary patency and major adverse events within 30 days. Secondary end points included lesion and procedure success, primary-assisted and secondary patency, major adverse events, stent migration, stent fracture, and quality of life changes. End point-related adverse events and imaging studies were adjudicated by independent clinical events committee and core laboratories, respectively. Results: Venous obstruction cause was classified as acute deep vein thrombosis (16.5%, 33/200), post-thrombotic syndrome (47.5%, 95/200), or nonthrombotic iliac vein lesion (36.0%, 72/200). The common iliac and external iliac veins were stented in 96.0% (192/200), 80.5% (161/200) of subjects, respectively. Stent implant into the common femoral vein was required in 44.0% (88/200). Primary patency at 12 months was 88.0% (162/184). Four (2.0%) major adverse events occurred within 30 days. Twelve-month primary-assisted and secondary patency were 91.8% (169/184) and 92.9% (171/184), respectively. No stent fractures or migrations were reported. Mean target limb Villalta score decreased from 11.2±5.6 at baseline to 4.1±4.8 at 12 months, and the mean target limb revised Venous Clinical Severity Score decreased from 8.8±4.7 at baseline to 4.3±3.6 at 12 months. Clinically meaningful improvements in quality of life and venous functional assessment scores from baseline were demonstrated through 12 months in all measures. Conclusions: Symptomatic iliofemoral venous obstruction can be successfully treated with an Abre venous stent. Study outcomes demonstrated a high patency rate with a good safety profile. Patients demonstrated a significant reduction in clinical symptoms and improvement in quality of life that was maintained through 12-month follow-up. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03038438.
Collapse
Affiliation(s)
- Erin Murphy
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC (E.M.)
| | | | - Marc Sapoval
- Hôpital Européen Georges-Pompidou, Paris, France (M.S.)
| | | | - Raghu Kolluri
- Ohio Health/Riverside Methodist Hospital, Columbus (R.K.)
| | | | | |
Collapse
|
14
|
Badesha AS, Khan G, Khan T. Reconstruction of an inferior vena cava stent occlusion using double-barrel stenting in a patient with Behçet's disease. Radiol Case Rep 2021; 17:235-239. [PMID: 34824658 PMCID: PMC8604737 DOI: 10.1016/j.radcr.2021.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022] Open
Abstract
Symptomatic inferior vena cava (IVC) and iliac vein thrombosis is increasingly being treated with thrombolysis, thrombus retrieval and deep venous stenting. If the IVC stent occludes, endovenous intervention is indicated to restore patency. An 18-year-old male with Behçet's disease presented with deep vein thrombosis (extending from the IVC to the popliteal segments bilaterally) which was initially treated with thrombolysis and stenting. Fifteen months later, the patient experienced symptomatic deterioration; a chronically-occluded IVC stent was identified and reconstructed using a double-barrel stenting technique. Patient compliance to post-stenting anticoagulation therapy is paramount to maintain stent patency. A multi-disciplinary approach including haematologists can be beneficial for patients with a background of thrombophilic disorders.
Collapse
Affiliation(s)
| | - Ghazn Khan
- Manchester Medical School, Medicine and Health, University of Manchester, Manchester, UK
| | - Taha Khan
- Manchester Vascular Service, Manchester, UK
| |
Collapse
|