A modification of iliac vein stent technique

Iliac vein stenting has emerged as a promising new technology to address a wide spectrum of advanced chronic venous disease. Wallstent™ has been the commonest stent type used in reported experience. It has excellent long-term patency with good clinical outcome, but is prone to compression/migration of the upper end of the stent requiring reinterventions. Extension of the stent into the vena cava to avoid this problem may render subsequent contralateral stenting technically difficult and possibly contribute to partial jailing of contralateral flow. A technical modification in which a Gianturco Z stent™ is added to the upper end of the Wallstent stack that may ameliorate some of these concerns is described.

The details of technique, complications, patency, and reinterventional rate of the Z stent modification in 217 limbs followed up to 24 months are reported.

Cumulative primary and secondary patency (24 months) were 69% and 93%, respectively. Eight stents were occluded and lysis restored patency in 6 patients. There was no mortality. Deep venous thrombosis (<30 day) occurred in 4% of patients similar to the incidence in native disease. Reinterventions were required in 11% of patients over the follow-up period to correct stent malfunction. Most of these (23/25) were related to the Wallstent tail of the combination stent stack. The Z stent modification provides increased radial strength at the iliac-caval junction which is a choke point. The Z stent modifications greatly facilitate staged or sequential bilateral stenting technique and may reduce the incidence of reinterventions related to retraction or compression of the upper end commonly seen with prior Wallstent experience.

The Z stent modification appears to improve functionality of the stent stack at the upper end and greatly facilitates simultaneous or staged bilateral stenting technique.