Predictive factors of venous stenting failure: a systematic review

Authors

DOI:

https://doi.org/10.48750/acv.435

Keywords:

Venous stent thrombosis, postthrombotic syndrome, may-thurner syndrome

Abstract

OBJECTIVE: Venous stenting of iliocaval obstructions has become a more frequent procedure over the last two decades. In-stent stenosis and thrombosis are potential complications, causing one of the main causes of symptoms recurrence and impacting quality of life. The aim of this review is to report on the impact of venous stent patency loss, as well on risk factors and management.

METHODS: A systematic review was conducted according to the recommendations of the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement.

RESULTS: After a literature search, 12 studies (two prospective and 10 retrospective studies) were included in the analysis. A total of 1981 patients (34.1% male) and 2388 limbs (63.6% left side) were assessed. Mean age was 43.5 years (range 16-99).

Indication for stenting included deep venous thrombosis (DVT) (4%), post-thrombotic syndrome (PTS) (18.8%) and non-thrombotic iliac vein lesions (NIVLs) (77.2%). Regarding treatment, most patients were submitted to angioplasty and stenting only (87%). Associated catheter directed thrombolysis or mechanical thrombectomy was performed when indicated (8.4%), and in the remaining an AVF/endophlebetomy was performed (4.6%).

Primary, primary assisted and secondary patency rates at one year ranged from 68-100%, 79-90% and 85.8-100%, respectively. Reported anticoagulation duration after stenting ranged from 1-12 months. In one study involving only patients treated for NIVLs, no anticoagulation was prescribed, and antithrombotic therapy was continued for three months. Follow-up strategies included clinical and imagiological control with a mean follow-up of 19.7 months.

Post-procedural stent re-stenosis was reported in 121 limbs (5.1%) and stent occlusion in 81 limbs (3.4%); the latter was distributed as follows: 11.1% after DVT, 77.8% PTS and 11.1% NIVLs. A total of 186 re-interventions were performed in symptomatic patients.

The prognostic factor most consistently associated with stent failure was thrombotic inflow veins. Other reported

factors were incomplete thrombolysis and age younger than 40 years. Stent placement below the inguinal ligament, type of stent and anticoagulation regimen do not seem to affect stent patency.

CONCLUSION: Regarding venous lesions of the lower limbs, a selective approach and planning should focus on identification of risk factors for stent failure. It is noteworthy that most stent occlusions occur in post-thrombotic limbs. Stent failure continued after 6 months, emphasizing the importance of an extended surveillance especially on these patients.

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References

Chait J, Alsheekh A, Aurshina A, Haggerty J, Ostrozhynskyy Y, Rajaee S, et al. Effect of venous access site on postintervention stent thrombosis for nonthrombotic iliac vein stenting. J Vasc Surg Venous Lymphat Disord 2020;8:84–8

van Vuuren TMAJ, Doganci S, Wittens CHA. Patency rates and clinical outcomes in a cohort of 200 patients treated with a dedicated venous stent. J Vasc Surg Venous Lymphat Disord 2018;6:321–9

Neglén P, Hollis KC, Olivier J, Raju S. Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg 2007;46:979-90

Xue GH, Huang XZ, Ye M, Liang W, Zhang H, Zhang JW, et al. Catheter- directed thrombolysis and stenting in the treatment of iliac vein compression syndrome with acute iliofemoral deep vein thrombosis: Outcome and follow-up. Ann Vasc Surg 2014;28:957–63

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta- analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700

Knipp B, Ferguson E, David MW, Narasimham JD, Wojciech Cwikie, Peter KH et al. Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome. J Vasc Surg 2007;46:743-9

Husmann MJ, Heller G, Kalka C, Savolainen H, Schmidli J, Baumgartner I. Stenting of Common Iliac Vein Obstructions Combined with Regional Thrombolysis and Thrombectomy in Acute Deep Vein Thrombosis. Eur J Vasc Endovasc Surg 2007:34, 87-91

Srinivas BC, Soumya P, Babu R, Nagesh CM, Naveen A, Manjunath CN. Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis: a prospective study with venous Doppler follow-up at 1-year. Cardiovasc Interv Ther 2015;30:320-6

Langwieser N, Bernlochner I, Wustrow I, Dirschinger R, Jaitner J, Dommasch M et al. Combination of factor Xa inhibition and antiplatelet therapy after stenting in patients with iliofemoral post-thrombotic venous obstruction. Phlebology 2016;31:430-7

Haqq RA, Novak Z, Pearce B, Matthews T, Patterson M, Jordan Jr M, Passman M. Routine extended follow-up surveillance of iliac vein stents for iliocaval venous obstruction may not be warranted. J Vasc Surg Venous and Lym Dis 2017;5:500-5

Jayaraj A, Buck W, Knight A, Johns B, Raju S, Jackson. Impact of degree of stenosis in May-Thurner syndrome on iliac vein stenting. J Vasc Surg: Venous and Lym Dis 2019;7:195-202

Menez C, Rodiere M, Ghelfi J, Seinturier C, Martinelli T, Imbert B, et al. Endovascular Treatment of Post-thrombotic Venous Ilio-Femoral Occlusions: Prognostic Value of Venous Lesions Caudal to the Common Femoral Vein. Cardiovas Intervent Radiol. 2019;42:1117-27

Sebastian T, Spirk D, Engelberger R, Dopheide J, Baumann F, Barco S, et al. Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome. Thromb Haemost 2019;119:2064-73

Avgerinos E, Saadeddin Z, Abou A, Pandya Y, Hager E, Singh M, et al. Outcomes and predictors of failure of iliac vein stenting after catheter- directed thrombolysis for acute iliofemoral thrombosis. J Vasc Surg Venous Lymphat Disord 2019;7:153-161

Bondarev S, Eric JK, Timothy H, Victoria AY, Suraj G, Robert LV, et al. Predictors of Disease Recurrence after Venoplasty and Stent Placement for May–Thurner Syndrome. J Vasc Interv Radiol 2019;30:1549–54

De Wolf MAF, De Graaf R, Kurstjens RLM, Penninx S, Jalaie H, Wittens CHA. Short-Term Clinical Experience with a Dedicated Venous Nitinol Stent: Initial Results with the Sinus-Venous Stent. Eur J Vasc Endovasc Surg 2015;50:518–26

O’Sullivan G, Sheehan J, Lohan D, Brown JA. Iliofemoral venous stenting. J Cardiovasc Surg 2013;54:255-61

Milinis K, Thapar A, Shalhoub J, Davies AH. Antithrombotic Therapy Following Venous Stenting: International Delphi Consensus. Eur J Vasc Endovasc Surg 2018;55:537–44

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Published

2023-01-07

How to Cite

1.
Semião AC, Nogueira C, Coelho A, Peixoto J, Fernandes L, Machado M, Basílio F, Canedo A. Predictive factors of venous stenting failure: a systematic review. Angiol Cir Vasc [Internet]. 2023 Jan. 7 [cited 2024 Mar. 28];18(3):192-6. Available from: https://acvjournal.com/index.php/acv/article/view/435

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Review Article