Journal of vascular surgery. Venous and lymphatic disorders · 2025
Results of dedicated venous nitinol stents in treating chronic inferior vena cava occlusions.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Wang Karissa M, Murphy Blake E, Hemingway Jake F
Аннотация
OBJECTIVE: Inferior vena cava (IVC) occlusion resulting from deep vein thrombosis (DVT) or embryologic developmental abnormalities can result in debilitating symptoms, including lower extremity pain, edema, and venous ulceration. This study describes the outcomes associated with endovascular recanalization and stenting of chronic IVC occlusions with dedicated venous nitinol stents.
METHODS: Patients who underwent endovascular recanalization and nitinol venous stenting at a single institution from 2022 to 2025 were identified. Demographics, comorbidities, CEAP classification, venous reconstruction details, and outcomes, including symptomatic improvement and 30-day complications, were collected. Descriptive analysis was completed. Primary and secondary patency was assessed using Kaplan-Meier analysis.
RESULTS: A total of 22 patients with symptomatic IVC occlusions underwent attempted recanalization. The median age at the time of treatment was 41 years (interquartile range [IQR], 37-71 years), and patients were predominantly male (77%). Patient comorbidities included active tobacco use (55%), hypertension (41%), and hypercoagulable disorders (32%). On presentation, 20 patients (91%) had post-thrombotic syndrome, 12 (55%) had CEAP class 4 to 6 chronic venous disease, six (27%) had occluded IVC filters, four (18%) had a prior failed venous intervention, and five (23%) had chronic stent occlusions. The etiology of chronic IVC occlusion included DVT in 13 patients (59%), IVC filter-associated thrombosis in four patients (18%), surgical-related IVC stenosis in two patients (9%), congenital abnormalities in two patients (9%), and IVC clipping in one patient (5%). Cranial extent of stenting was infrarenal in 11 patients (52%) and suprarenal in 10 patients (48%). Common femoral veins were stented in 27 patients (64% of limbs). Sharp recanalization was required in three patients (14%). A total of 21 patients (95%) achieved technical success. All patients were anticoagulated postoperatively, and the median length of stay was 1 day (IQR, 0-2 days). Two patients (9.5%) experienced bleeding-related complications within 30 days. The median follow-up was 259 days (IQR, 78-473 days). Primary patency for the IVC stents was 100% at 12 months. Primary and secondary patency for all components within the venous reconstruction, including IVC and iliofemoral stents, was 84% and 100% at 1 year, respectively. All patients reported symptomatic improvement and venous ulcers healing (if present at index presentation) within 1 year following intervention.
CONCLUSIONS: Treatment of chronic IVC occlusions using dedicated venous nitinol stents is safe with excellent midterm patency and symptom improvement at 1 year postoperatively. Multi-institutional studies with larger patient populations and standardized outcomes, including quality of life and cost measures, are required to further validate the study findings.
METHODS: Patients who underwent endovascular recanalization and nitinol venous stenting at a single institution from 2022 to 2025 were identified. Demographics, comorbidities, CEAP classification, venous reconstruction details, and outcomes, including symptomatic improvement and 30-day complications, were collected. Descriptive analysis was completed. Primary and secondary patency was assessed using Kaplan-Meier analysis.
RESULTS: A total of 22 patients with symptomatic IVC occlusions underwent attempted recanalization. The median age at the time of treatment was 41 years (interquartile range [IQR], 37-71 years), and patients were predominantly male (77%). Patient comorbidities included active tobacco use (55%), hypertension (41%), and hypercoagulable disorders (32%). On presentation, 20 patients (91%) had post-thrombotic syndrome, 12 (55%) had CEAP class 4 to 6 chronic venous disease, six (27%) had occluded IVC filters, four (18%) had a prior failed venous intervention, and five (23%) had chronic stent occlusions. The etiology of chronic IVC occlusion included DVT in 13 patients (59%), IVC filter-associated thrombosis in four patients (18%), surgical-related IVC stenosis in two patients (9%), congenital abnormalities in two patients (9%), and IVC clipping in one patient (5%). Cranial extent of stenting was infrarenal in 11 patients (52%) and suprarenal in 10 patients (48%). Common femoral veins were stented in 27 patients (64% of limbs). Sharp recanalization was required in three patients (14%). A total of 21 patients (95%) achieved technical success. All patients were anticoagulated postoperatively, and the median length of stay was 1 day (IQR, 0-2 days). Two patients (9.5%) experienced bleeding-related complications within 30 days. The median follow-up was 259 days (IQR, 78-473 days). Primary patency for the IVC stents was 100% at 12 months. Primary and secondary patency for all components within the venous reconstruction, including IVC and iliofemoral stents, was 84% and 100% at 1 year, respectively. All patients reported symptomatic improvement and venous ulcers healing (if present at index presentation) within 1 year following intervention.
CONCLUSIONS: Treatment of chronic IVC occlusions using dedicated venous nitinol stents is safe with excellent midterm patency and symptom improvement at 1 year postoperatively. Multi-institutional studies with larger patient populations and standardized outcomes, including quality of life and cost measures, are required to further validate the study findings.