Iliac vein stent failure in community practice and results of corrective reinterventions

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2023-05, Vol.11 (3), p.525-531.e3
• Main Authors: Saleem, Taimur, Barry, Owen, Thaggard, David, Peeples, Hunter, Raju, Seshadri
• Format: Article
• Language: English
• Subjects: Adult; Aged; Constriction, Pathologic; Humans; Iatrogenic Disease; Iatrogenic stenosis; Iliac Vein; Iliac vein stent; In-stent restenosis; Intravascular ultrasound; IVUS; Middle Aged; Poor inflow; Retrospective Studies; Stent occlusion; Stents; Treatment Outcome
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2022.12.007

The goal of endovenous stenting is to relieve venous obstruction and reduce peripheral venous hypertension by using large caliber venous stents in the presence of adequate venous inflow and outflow for the stented conduit. The aim of this report is to describe the technical reasons and outcomes for reinterventions in a subset of patients who had a history of iliac vein stenting and were now referred to us at a specialty venous clinic for further care. From January 2016 to December 2021, records of all patients who were referred to us with a history of iliac vein stenting performed at an outside facility and who had a reoperation performed at our center were retrospectively analyzed. A total of 149 limbs underwent a deep venous reintervention after a failure of a trial of conservative therapy. The mean age of the sample was 57 ± 16 years. The ratio of non-thrombotic iliac vein lesions to post-thrombotic lesions was 1:2.5. The majority of the patients (84%) were CEAP class C4 or higher. The most common reason for reintervention was stent occlusion (74%), followed by iatrogenic stenosis (53%) and in-stent restenosis/shelving (38%). There was a trend for improvement in all clinical parameters (venous clinical severity score, visual analog scale for pain, and edema grade) after the reintervention. Poor inflow was present in 70% of limbs with stent occlusion. The median diameters of stented common femoral vein, external iliac vein, and common iliac vein prior to reintervention were 12, 12, and 13 mm, respectively. The median diameters of stented common femoral vein, external iliac vein, and common iliac vein after reintervention were 14, 15, and 16 mm, respectively. Eighty-eight percent of limbs required at least one further reintervention after initial reoperation. Venous reoperations are generally infrequent and required in a small number of patients. Poor inflow appeared to be a common cause of stent occlusion. Iatrogenic stenosis is another common reason for venous reoperation and is difficult to fully rectify through current endovascular techniques and tools. Use of intravascular ultrasound planimetry routinely in every deep venous intervention and thorough knowledge of the principles of venous stenting outlined in this report may help forestall the need for reoperative deep venous surgery in some cases.