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Huang T, Yin Y, Ding W, Jin Y, Hong X, Li X, Ni C. The Safety and Efficacy of ZelanteDVT™ Catheter Rheolytic Thrombectomy in the Treatment of Patients with Iliac Vein Stent Thrombosis. Ann Vasc Surg 2024; 106:205-212. [PMID: 38823479 DOI: 10.1016/j.avsg.2024.03.006] [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: 12/06/2023] [Revised: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND To examine the safety and efficacy of ZelanteDVT™ catheter rheolytic thrombectomy in the treatment of patients with iliac vein stent thrombosis. METHODS A retrospective analysis method was conducted by means of collecting the data of 32 patients who had completed the treatment of iliac vein stent thrombosis with ZelanteDVT catheter rheolytic thrombectomy from March 2019 to March 2023. Data on clinical characteristics, technical success, clinical success, complications, and early follow-up were analyzed. RESULTS The technical success rates were 100%, intraoperatively, in which 22 cases were improved to thrombus clearance Grade II (50-90%), 10 were Grade III (>90%). There were 21 cases treated with subsequent catheter-directed thrombolysis, and the average urokinase administration of (120.90 ± 29.63)∗10ˆ4 units. The clinical success rates were 100% and the swelling of the affected limbs were significantly improved, a significant difference in the pre/postoperative between-thigh circumference difference [(5.16 ± 1.08) vs. (1.75 ± 0.84), P < 0.000]. The pre/postoperative Venous Clinical Severity Score was [(12.94 ± 1.70) vs. (7.44 ± 1.31), P < 0.000]. No serious complications occurred during the perioperative period. The postoperative and 12-month stent patency rate was 100.00% (32/32) and 71.88% (23/32), respectively. CONCLUSIONS The ZelanteDVT catheter rheolytic thrombectomy seems to have a promising application prospect for the treatment of patients with iliac vein stent thrombosis.
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Affiliation(s)
- Tianan Huang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Interventional Radiology, Nantong First People's Hospital, Nantong, Jiangsu, China
| | - Yu Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wenbin Ding
- Department of Interventional Radiology, Nantong First People's Hospital, Nantong, Jiangsu, China
| | - Yonghai Jin
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Hong
- Department of Interventional Radiology, Nantong First People's Hospital, Nantong, Jiangsu, China
| | - Xinqing Li
- Department of Vascular Surgery Department, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Caifang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Nguyen D, Pappas K, Mahadevan S, Sulakvelidze L, Kennedy R, Lakhanpal G, Lakhanpal S, Pappas PJ. The impact of stent protrusion into the inferior vena cava or jailing of the contralateral iliac vein on the incidence of contralateral deep vein thrombosis following venous stenting. Phlebology 2024:2683555241273752. [PMID: 39138919 DOI: 10.1177/02683555241273752] [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: 08/15/2024]
Abstract
OBJECTIVE Iliac vein stenting is the standard of care for patients with pelvic venous disorders secondary to symptomatic iliac vein outflow obstruction. Venous stents are often extended proximally into the inferior vena cava (IVC) which may result in partial or complete coverage of the contralateral iliac vein. The purpose of this investigation is to determine if extension of iliac vein stents into the IVC results in increased risk of contralateral deep venous thrombosis (DVT). METHODS We retrospectively reviewed prospectively collected data from 409 patients who underwent iliac vein stenting at the Center for Vascular Medicine (CVM) from 2019 to 2020. Stent type, covered territories, initial and follow-up consults, ultrasound and operative reports were reviewed to assess for incidence of post-implantation DVT. Patients were stratified into three groups: Iliac vein stents which protruded into the IVC, stents that completely covered the orifice of the contralateral iliac vein and those with no stent protrusion into the IVC. RESULTS Out of 409 patients, the average age was 53.96 ± 13.40 years with 94 males and 315 females. All stents placed were Venovo stents and all iliac vein lesions were non-thrombotic stenoses. The average follow-up period was 14.35 ± 10.09 months. The most common territories stented were the IVC-LCIV-LEIV (n = , 74%) and the IVC-RCIV-REIV (n = , 26%). Stent protrusion and distance into the IVC in millimeters (mm) was the following: Partial protrusion (n = 314, 77%, 27.6 ± 19.1), jailing of the contralateral iliac vein (n = 78, 19%, 45.9 ± 18.6), no protrusion (n = 16, 4%). The overall DVT rate post-implantation was 0.49% (n = 2). No DVTs ipsilateral to the index stent were identified and both DVTs were contralateral DVTs. A hypercoaguable disorder was reported in 6 patients (1.5%). There were no significant differences in prevalence of contralateral DVT between the three groups. (p = .35). CONCLUSION The rate of contralateral DVTs post iliac vein stenting with Nitonol based stents is extremely low. Partial or complete coverage of the contralateral iliac vein via stenting does not result in an increased incidence of contralateral DVT in the short-term. Longer follow up is needed to determine if contralateral DVTs occur after long-term implantation.
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Affiliation(s)
- Duy Nguyen
- Center for Vascular Medicine, Glen Burnie, MD, USA
| | - Karl Pappas
- Center for Vascular Medicine, Glen Burnie, MD, USA
| | | | | | | | | | - Sanjiv Lakhanpal
- Center for Vascular Medicine, Glen Burnie, MD, USA
- Center for Vein Restoration, Greenbelt, MD, USA
| | - Peter J Pappas
- Center for Vascular Medicine, Glen Burnie, MD, USA
- Center for Vein Restoration, Greenbelt, MD, USA
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Solano A, Klein A, Gonzalez-Guardiola G, Chamseddin K, Prakash V, Shih M, Baig MS, Timaran CH, Kirkwood ML, Siah MC. RevCore thrombectomy system for treatment of chronic left external and common iliac vein stent occlusion. J Vasc Surg Cases Innov Tech 2024; 10:101482. [PMID: 38633580 PMCID: PMC11022097 DOI: 10.1016/j.jvscit.2024.101482] [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: 12/05/2023] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
In recent years, deep venous stenting has increasingly become a treatment strategy for post-thrombotic syndrome. Stent thrombosis can occur, resulting in symptom recurrence despite medical therapy, and there are few options available for durable stent patency restoration. We present a case of a 50-year-old male with prior iliocaval reconstruction that experienced recurrent left lower extremity swelling secondary to occlusion of left external iliac and common iliac vein stents during follow-up. Mechanical thrombectomy with the RevCore System and angioplasty was performed. One month later, the patient demonstrated widely patent bilateral iliac vein stents and complete symptomatic resolution. The RevCore System is a feasible alternative for treatment of chronic in-stent thrombosis.
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Affiliation(s)
- Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrea Klein
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - M. Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H. Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael C. Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Montoya C, Polania-Sandoval C, Almeida JI. Endovascular mechanical thrombectomy of iliofemoral venous stent occlusion with the novel RevCore thrombectomy system: case reports and literature review. J Vasc Surg Cases Innov Tech 2024; 10:101432. [PMID: 38510090 PMCID: PMC10951538 DOI: 10.1016/j.jvscit.2024.101432] [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: 10/30/2023] [Accepted: 01/05/2024] [Indexed: 03/22/2024] Open
Abstract
Venous in-stent restenosis is not completely understood, and the currently available treatment is usually unsatisfactory. We describe the cases of two patients treated with the RevCore thrombectomy system (Inari Medical), designed for venous in-stent thrombosis. Case 1 involves a 62-year-old woman with post-thrombotic syndrome from iliac vein stent placement 15 years earlier. Case 2 describes a 30-year-old woman with post-thrombotic syndrome from recurrent iliac vein stent occlusion, despite therapeutic anticoagulation. Both patients had previous recanalization attempts at outside facilities that were unsuccessful. The RevCore system was safe and feasible in these initial cases, and more studies are warranted.
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Affiliation(s)
- Christopher Montoya
- Division of Vascular and Endovascular Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Camilo Polania-Sandoval
- Division of Vascular and Endovascular Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Jose I. Almeida
- Division of Vascular and Endovascular Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
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Li G, Hu B, Sun Y, Huang X, Zhang X. Histological Features of In-Stent Restenosis after Iliac Vein Thrombus Removal and Stent Placement in a Goat Model. J Vasc Interv Radiol 2024; 35:611-617. [PMID: 38171414 DOI: 10.1016/j.jvir.2023.12.567] [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: 08/07/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE To establish an animal model for in-stent restenosis (ISR) after postthrombotic iliac vein stent placement and characterize histopathological changes in tissue within the stented vein. MATERIALS AND METHODS Iliac vein thrombosis was induced using balloon occlusion and thrombin injection in 8 male Boer goats. Mechanical thrombectomy and iliac vein stent placement were performed 3 days after thrombosis induction. Restenosis was evaluated by venography and optical coherence tomography (OCT) at 1 and 8 weeks after stent placement, and stent specimens were taken for pathological examination after the animals were euthanized. RESULTS Thrombosis induction was successful in all 8 goats, with >80% iliac vein occlusion. After thrombus removal, OCT revealed considerable venous intimal thickening and a small number of mural thrombi. Neointimal hyperplasia with thrombus formation was observed in all goats 1 week after stent implantation; the degree of ISR was 15%-33%. At 8 weeks, the degree of ISR was 21%-32% in 3 goats, and stent occlusion was observed in 1 goat. At 1 week, the neointima predominantly consisted of fresh thrombi. At 8 weeks, proliferplastic fibrotic tissue and smooth muscle cells (SMCs) were predominant, and the stent surfaces were endothelialized in 2 of 3 goats and partially endothelialized in 1 goat. CONCLUSIONS In the goat model, postthrombotic neointimal hyperplasia in the venous stent may result from time-dependent thrombus formation and organization, accompanied by migration and proliferation of SMCs, causing ISR. These results provide a basis to further explore the mechanism of venous ISR and promote the development of venous stents that reduce neointimal hyperplasia.
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Affiliation(s)
- Guanqiang Li
- Department of Vascular Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Bo Hu
- Department of Vascular Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Yuan Sun
- Department of Vascular Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Xianchen Huang
- Department of Vascular Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Xicheng Zhang
- Department of Vascular Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China.
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Villalba L, Bayat I, Dubenec S, Puckridge P, Thomas SD, Varcoe RL, Vasudevan T, Tripathi RK. RETRACTED: Australian and New Zealand Society for Vascular Surgery clinical practice guidelines on venous outflow Obstruction of the femoral-iliocaval veins. J Vasc Surg Venous Lymphat Disord 2023; 11:832-842. [PMID: 37085086 DOI: 10.1016/j.jvsv.2023.02.002] [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: 12/16/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND The overall goal of this report is to provide a high-level, practical approach to managing venous outflow obstruction (VOO) in Australia and New Zealand. METHODS A group of vascular surgeons from the Australian and New Zealand Society for Vascular Surgery with specific interest, training, and experience in the management of VOO were surveyed to assess current local practice. The results were analyzed and areas of disagreement identified. Following this, the group performed a literature review of consensus guidelines published by leading international organizations focused on the management of chronic venous disease, namely the Society for Vascular Surgery, American Venous Forum, European Society for Vascular Surgery, American Vein and Lymphatic Society, Cardiovascular and Interventional Radiology Society of Europe, and American Heart Association. These guidelines were compared against the consensus statements obtained through the surveys to determine how they relate to Australian and New Zealand practice. In addition, selected key studies, reviews, and meta-analyses on venous stenting were discussed and added to the document. Finally, a selection of statements with >75% agreement was voted on, and barriers to the guideline's applicability were identified. RESULTS The document addresses two key areas: patient selection and technical aspects of venous stenting. Regarding patient selection, patients with a CEAP (Clinical-Etiologic-Anatomic-Physiologic) score of ≥3 or a venous clinical severity score for pain of ≥2, or both, and evidence of >50% stenosis on venography, computed tomography venography, magnetic resonance venography, and/or intravascular ultrasound should be considered for venous stenting (level of recommendation Ib) Patients undergoing thrombus removal for acute iliofemoral deep vein thrombosis, in whom a culprit stenotic lesion has been uncovered, should be considered for venous stenting (level of recommendation Ib). Patients with chronic pelvic pain, deep dyspareunia, postcoital pain affecting their quality of life, when other causes have been ruled out, should be considered for venous stenting (level of recommendation Ic). Asymptomatic patients should not be offered venous stenting (level of recommendation IIIc). CONCLUSIONS Patients with deep VOO have been underdiagnosed and undertreated for decades; however, in recent years, interest from physicians and industry has grown substantially. The advent of simpler and safer treatment options has revolutionized its management, but, unfortunately, formal training for venous disease has not grown at the same rate. Simplifying the technology and training required can result in inconsistent outcomes. These guidelines are aimed at developing standards of care and will serve as an educational platform for future developments.
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Affiliation(s)
- Laurencia Villalba
- Department Vascular Surgery, The Wollongong Hospital, Wollongong, NSW, Australia.
| | - Iman Bayat
- Department Vascular Surgery, The Northern Hospital, Melbourne, VIC, Australia
| | - Steven Dubenec
- Department Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Philip Puckridge
- Department Vascular Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | | | - Ramon L Varcoe
- Department Vascular Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Thodur Vasudevan
- Department Vascular Surgery, The Alfred Hospital, Melbourne, VIC, Australia
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