Venous stenting across the inguinal ligament

• Published in: Journal of vascular surgery 2008-11, Vol.48 (5), p.1255-1261
• Main Authors: Neglén, Peter, MD, PhD, Tackett, T. Paul, BS, Raju, Seshadri, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Cardiovascular system; Female; Femoral Vein - diagnostic imaging; Femoral Vein - surgery; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Humans; Iliac Vein - diagnostic imaging; Iliac Vein - surgery; Ligaments; Male; Medical sciences; Middle Aged; Peripheral Vascular Diseases - diagnostic imaging; Peripheral Vascular Diseases - surgery; Pharmacology. Drug treatments; Phlebography; Prosthesis Design; Registries; Stainless Steel; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular wall; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.06.035

Background Arterial stenting across joints is not recommended because of increased risk of in-stent focal neointimal hyperplasia and compression or fracture of the stent by joint motion with decreased long-term patency. The aim of this study was to assess the risk of placing stents in the venous system across the inguinal ligament. Materials and Methods From 1997 to 2006, 177 limbs with chronic non-malignant obstructive lesions had stents placed in the iliofemoral venous outflow across the inguinal ligament into the common femoral vein. Transfemoral venograms and duplex ultrasound scans to assess cumulative patency rates, cumulative rates, site of in-stent restenosis (ISR), and structural integrity of the stents were performed during follow-up. The results were compared to the findings in 316 limbs with stents terminating cephalad to the inguinal ligament. Results Overall cumulative secondary patency (CSP) rate at 54 months was greater in the limbs with cephalad than in those caudad stent termination in relation to the inguinal ligament (95% and 86%, respectively; P = .0001). Although CSP of limbs with non-thrombotic obstruction was 100% regardless of the site of stent termination, that of the limbs stented for thrombotic obstruction was greater for stents terminating cephalad than for those caudad to the ligament (90% and 84%, respectively; P = .0378). However, a comparison of CSP rates between limbs treated for thrombotic occlusion and those with thrombotic non-occlusive obstruction at 32 months revealed no difference whether or not the stent was placed across the inguinal ligament (occlusion 77% and 77%, P = .7540, non-occlusive obstruction 96% and 95%, P = .7437). Severe ISR (≥50%) were rare, 5%. The cumulative rate was, however, not significantly different in limbs stented cephalad and caudad to the inguinal ligament (7% and 11%, respectively, P = .6393). Focal in-stent recurrent stenosis at the site of the inguinal ligament occurred in only 7% of limbs (all