A meta-analysis of the medium- to long-term outcomes in patients with chronic deep venous disease treated with dedicated venous stents.

OBJECTIVE: This review summarizes the safety profile, stent patency, and clinical effectiveness of dedicated venous stents for the treatment of chronic deep venous disease. The approaches to stenting and post-procedural management of different vascular units are also explored. METHODS: The MEDLINE and Embase databases were searched for pertinent literature published from January 2010 to January 2023. Outcomes related to post-stenting symptoms and health-related quality of life were described narratively. A meta analysis was conducted to evaluate stent patency, ulcer healing, bleeding, and 30-day stent thrombosis, and these outcomes were presented as proportion event rates. RESULTS: Seventeen studies were identified comprising of 2218 patients. 62.7% of individuals had post-thrombotic stenosis or occlusion. The majority of patients (78.6%) were noted to have complete occlusions of their deep veins before stenting. Eleven different dedicated venous stents were deployed. At 12 months, the primary patency rate was 83% (95% confidence interval [CI]: 76%-90%), the primary-assisted patency rate was 90% (95% CI: 85%-96%), and the secondary patency rate was 95% (95% CI: 92%-98%). A significant improvement in health-related quality of life was demonstrated after intervention. In total, 68.8% (95% CI: 52.0%-83.7%) of ulcers healed at the last follow-up. The remaining symptomatic changes were described narratively; improvements in pain, venous claudication, and edema after stenting were observed. Seventeen deaths occurred, but none were linked to the stenting procedures. A total of 159 cases (7.2% of patients) of in-stent stenosis were observed, whereas 110 stents (5.0% of patients) were occluded. The incidence of major and minor bleeding was 1.7% (95% CI: 1.0%-2.5%) and 3.2% (95% CI: 1.3%-5.6%), respectively, more commonly seen in patients undergoing hybrid intervention. CONCLUSIONS: Deep venous stenting using dedicated venous stents is a safe technique to treat chronic deep venous stenosis and/or occlusion. Within the limitations of this study, deep venous stenting is associated with good patency rates and symptomatic improvement.

Iliac vein deep vein thrombosis as an atypical presentation of an adrenocortical carcinoma.

Adrenocortical carcinoma (ACC) is a rare form of cancer with an annual incidence of two per million. The risk of venous thromboembolism increases sevenfold in patients with cancer. This case report describes an iliac vein deep vein thrombosis (DVT) as an atypical presentation of an ACC and highlights the value of further imaging investigation in patients with unprovoked DVTs.

A Systematic Review on the Incidence of Stent Migration in the Treatment of Acute and Chronic Iliofemoral Disease Using Dedicated Venous Stents.

OBJECTIVES: This systematic review investigated the incidence of stent migration in patients with acute and chronic deep venous iliofemoral disease who were treated with dedicated venous stents. Procedural approaches, clinical and stent patency outcomes, and other complications are described. METHODS: MEDLINE and Embase were searched for literature published from January, 2012 to December, 2021. Evidence on the study population and procedural characteristics, and outcomes related to symptomatic changes, health-related quality of life, stent patency and complications was presented. RESULTS: Fourty-two studies were identified from 857 articles found through the database searches. Five-hundred seventy acute deep vein thrombosis patients and 2,859 chronic disease patients were included. Ten dedicated venous stent brands were employed. There were six episodes of stent migration (0.17% of patients) of which three involved a closed-cell stent and one involved a hybrid-design stent. The 12-month primary patency rate in patients with acute deep vein thrombosis ranged from 86 to 88%, whilst secondary patency was 96%. Amongst the chronic-disease cohort the primary and secondary patency were noted to range from 59 to 94%, and 87 to 100%, respectively. The pooled 12-month primary and secondary stent patency rates were 73.8% and 91.5%, respectively. CONCLUSIONS: Iliofemoral stenting using dedicated venous stents is associated with a low rate of stent migration although this may be due to a lack of reporting. Further research with specific surveillance protocols is necessary to reliably determine the true incidence of stent migration.

A systematic review and meta-analysis of the treatment of obstructive chronic deep venous disease using dedicated venous stents.

OBJECTIVE: This review aims to summarise the efficacy and safety of dedicated venous stenting for the treatment of obstructive chronic deep venous disease. The approaches to stenting and post-procedural management of different vascular units are also highlighted. METHODS: MEDLINE and Embase were searched to identify relevant literature on dedicated venous stents published from January 2010 to May 2020. The patient population and study characteristics; procedural characteristics; and outcomes related to post-stenting symptoms, health-related quality of life, patency, and complications were analyzed. RESULTS: Sixteen single-arm observational studies were included from 2366 studies identified from key word searches. In total, 1688 patients were included, of which 70.5% had post-thrombotic syndrome and the remainder had nonthrombotic iliac vein lesions. Nine studies (n = 848) stated whether lesions were stenotic (36.6%) or occlusive (63.4%). Seven studies did not report the lesion characteristics (n = 840). Eight different dedicated venous stent brands were used. At the last follow-up, 73.4% of ulcers had healed. The remaining symptomatic changes were described narratively; sustained improvements in pain, venous claudication, and edema after stenting were observed. Significant post-stenting improvements in health-related quality of life were noted, as measured by the Chronic Venous Insufficiency Questionnaire-20 instrument. Overall, the most frequently reported complications were in-stent occlusion (n = 204), in-stent stenosis (n = 149), and minor bleeding (n = 77). At 12 months, the primary patency ranged from 59% to 94%, whereas the secondary patency ranged 87% to 100%. The pooled primary and secondary stent patency rates at 12 months were 74.0% and 90.4%, respectively. The incidence of major and minor bleeding was 1.9% and 4.7%, respectively; bleeding complications were more common in patients undergoing hybrid interventions. CONCLUSIONS: Deep venous stenting using dedicated venous stents is a safe technique to treat obstructive chronic deep venous disease and within the limitations of this study, is associated with good patency outcomes and symptomatic improvement.

Reconstruction of an inferior vena cava stent occlusion using double-barrel stenting in a patient with Behçet's disease.

Symptomatic inferior vena cava (IVC) and iliac vein thrombosis is increasingly being treated with thrombolysis, thrombus retrieval and deep venous stenting. If the IVC stent occludes, endovenous intervention is indicated to restore patency. An 18-year-old male with Behçet's disease presented with deep vein thrombosis (extending from the IVC to the popliteal segments bilaterally) which was initially treated with thrombolysis and stenting. Fifteen months later, the patient experienced symptomatic deterioration; a chronically-occluded IVC stent was identified and reconstructed using a double-barrel stenting technique. Patient compliance to post-stenting anticoagulation therapy is paramount to maintain stent patency. A multi-disciplinary approach including haematologists can be beneficial for patients with a background of thrombophilic disorders.

Management of Acute Iliofemoral Deep Venous Thrombosis in Inflammatory Bowel Disease - Transitioning From Conservative Management to Early Intervention.

Deep vein thrombosis (DVT) is a frequent complication in patients suffering from inflammatory bowel disease (IBD), especially in those with frequent relapses of the disease or extensive inflammatory lesions. The aetiology for the increased risk is multifactorial. Current evidence on management of acute iliofemoral DVT in IBD patients is scarce. This case series highlights two cases of active IBD, who developed acute iliofemoral DVTs and were treated with catheter-directed thrombolysis (CDT). This report demonstrates that CDT is effective in clearing the clot burden and producing significant symptomatic improvement in the absence of major complications. An individualised approach must be taken for the management of IBD patients with acute iliofemoral DVT.