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Published on: July 11, 2019
Iliocaval Confluence Stenting for Chronic Venous Obstructions.
Rick de Graaf1, Mark de Wolf2, Anna M Sailer3
1Department of Radiology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. r.de.graaf@mumc.nl.
This study compared two stenting methods for chronic bi-iliocaval obstructions. Balloon-expandable stents showed higher short-term patency for the iliocaval confluence, suggesting a promising treatment option for venous stenting.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Chronic bi-iliocaval obstruction is a severe venous disease.
- Stenting is a common treatment for venous obstructions.
- Different techniques exist for stenting the iliocaval confluence.
Purpose of the Study:
- To compare two distinct confluence stenting techniques for chronic bi-iliocaval obstructions.
- To report the clinical experience and outcomes of these stenting methods.
Main Methods:
- Retrospective analysis of 40 patients with chronic total bi-iliocaval obstructions (11/2009-08/2014).
- Patients underwent stenting of the inferior vena cava (IVC) with self-expandable stents.
- Confluence bridging used either self-expandable stents (SECS group, n=24) or balloon-expandable stents (BECS group, n=16).
- Bilateral iliac extensions were performed with nitinol stents.
Main Results:
- Successful recanalization in all patients.
- 15 patients (38%) required hybrid procedures (endophlebectomy, AV fistula).
- Overall 36-month primary, assisted-primary, and secondary patency rates were 70%, 73%, and 78%.
- Twelve-month patency rates: SECS group (85%, 85%, 95%), BECS group (100% primary patency at mean 134 days).
Conclusions:
- Stenting for chronic bi-iliocaval obstruction yields high medium-term patency rates.
- Balloon-expandable stents at the confluence appear to offer superior short-term patency.
- Further research is needed to confirm long-term efficacy of different confluence stenting techniques.
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