Venous stenting across the inguinal ligament

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Vascular Medicine

Background:

• Arterial stenting across joints is generally contraindicated due to risks of neointimal hyperplasia, stent compression, and reduced patency.
• The safety and efficacy of venous stenting across the inguinal ligament, a critical anatomical junction, required assessment.

Purpose of the Study:

• To evaluate the risks associated with placing iliofemoral venous stents across the inguinal ligament.
• To compare outcomes of venous stenting across the inguinal ligament versus stents terminating cephalad to it.

Main Methods:

• A retrospective analysis of 177 limbs with chronic obstructive venous lesions treated with stents across the inguinal ligament from 1997-2006.
• Follow-up included transfemoral venograms and duplex ultrasound scans to assess cumulative patency, in-stent restenosis (ISR), and stent integrity.
• Comparison was made with 316 limbs where stents terminated cephalad to the inguinal ligament.

Main Results:

• Overall cumulative secondary patency (CSP) at 54 months was 86% for stents across the ligament versus 95% for those cephalad (P=.0001).
• For thrombotic obstructions, CSP was 84% caudad vs. 90% cephalad (P=.0378); however, no difference was seen for occlusive vs. non-occlusive thrombotic cases.
• Severe ISR (>50%) was rare (5%), with no significant difference in rates between cephalad and caudad stent placement (7% vs. 11%, P=.6393). No stent fractures or compressions occurred.

Conclusions:

• Braided stainless steel stents can be safely deployed in the venous system across the inguinal ligament.
• Venous stenting across the inguinal ligament does not increase risks of fracture, compression, or severe ISR, and does not negatively impact long-term patency.
• Venous patency is primarily determined by the etiology of obstruction (thrombotic vs. non-thrombotic, occlusive vs. non-occlusive) rather than stent placement relative to the inguinal ligament.