Lower Extremity Venous Stent Placement: A Large Retrospective Single-Center Analysis |
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| Institution: | 1. Department of Radiology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305;2. Department of Radiology, CHA University Bundang Medical Center, Seongnam, South Korea;3. Department of Radiology, Shanghai General Hospital, Shanghai, China;4. Department of Radiology, Chinese PLA General Hospital, Beijing, China;5. Department of Radiology, Palo Alto Veterans Administration Health Care System, Palo Alto, California;1. Department of Vascular Surgery, University Hospital Aachen, Pauwelsstrasse 30, Aachen 52074, Germany;2. Clinic for Diagnostic and Interventional Radiology/Nuclear Medicine, Clinical Center of Friedrichshafen, Friedrichshafen, Germany;3. Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey;4. Heart and Vascular Center, St. Joseph Hospital, Orange, California;1. Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany;2. Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany;3. Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany;4. Department of Thoracic Oncology, Thoraxlinik University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany;5. Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany;1. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn;2. Department of Radiology, Yale University School of Medicine, New Haven, Conn;3. Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Conn;4. Section of Cardiology, Yale University School of Medicine, New Haven, Conn;1. The RANE Center for Venous & Lymphatic Diseases, St. Dominic Hospital, Jackson, Miss;2. Mississippi College, Clinton, Miss;1. Heart and Vascular Center, St. Joseph Hospital, Orange, Calif;2. Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC;3. Department of Surgery, Guy''s and St. Thomas'' Hospital, London, United Kingdom;4. Syntactx, New York, NY;5. SP Vascular Center, Limassol, Cyprus |
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| Abstract: | PurposeTo study short-term and long-term outcomes of lower extremity venous stents placed at a single center and to characterize changes in vein diameter achieved by stent placement.Materials and MethodsA database of all patients who received lower extremity venous stents between 1996 and 2018 revealed 1,094 stents were placed in 406 patients (172 men, 234 women; median age, 49 y) in 513 limbs, including patients with iliocaval stents (9.4% acute thrombosis, 65.3% chronic thrombosis, 25.3% nonthrombotic lesions). Primary, primary assisted, and secondary patency rates were assessed for lower extremity venous stents at 1, 3, and 5 years using Kaplan-Meier analyses and summary statistics. Subset analyses and Cox regression were performed to identify risk factors for patency loss. Vein diameters and Villalta scores before and up to 12 months after stent placement were compared. Complication and mortality rates were calculated.ResultsPrimary, primary assisted, and secondary patency rates at 5 years were 57.3%, 77.2%, and 80.9% by Kaplan-Meier methods and 78.6%, 90.3%, and 92.8% by summary statistics. Median follow-up was 199 days (interquartile range, 35.2–712.0 d). Patency rates for the subset of patients (n = 46) with ≥ 5 years of follow-up (mean ± SD 9.1 y ± 3.4) were nearly identical to cohort patency rates at 5 years. Patients with inferior vena cava stent placement (hazard ratio 2.11, P < .0001) or acute thrombosis (hazard ratio 3.65, P < .0001) during the index procedure had significantly increased risk of losing primary patency status. Vein diameters were significantly greater after stent placement. There were no instances of stent fracture, migration, or structural deformities. In patients with chronic deep vein thrombosis, Villalta scores significantly decreased after stent placement (from 15.7 to 7.4, P < .0001). Perioperative mortality was < 1%, and major perioperative complication rate was 3.7%.ConclusionsCavo-ilio-femoral stent placement for venous occlusive disease achieves improvement of vein disease severity scores, increase in treated vein diameters, and satisfactory long-term patency rates. |
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| Keywords: | DVT"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"deep vein thrombosis IVC"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"inferior vena cava LCIV"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"left common iliac vein LEIV"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"left external iliac vein RCIV"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"right common iliac vein |
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