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Novel Approach to Treatment of Chronic Iliocaval Occlusion Utilizing Covered Stents
Sean Flynn1, Rachel Jensen1, John Lane2
1Department of Surgery, University of California, San Diego, San Diego, CA.
Insights
Covered stents offer a safe and effective solution for chronic iliocaval obstruction, significantly improving patient symptoms and maintaining high patency rates. This novel approach shows promise for challenging venous stenting cases.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Chronic iliocaval obstruction presents significant treatment challenges.
- Endovenous stenting is a primary treatment for central vein stenosis and occlusion.
- Outcomes in thrombotic iliocaval disease have historically been less robust than in non-thrombotic cases.
Purpose of the Study:
- To evaluate the feasibility, safety, and outcomes of using covered stents for chronic total occlusions of the iliocaval veins.
- To describe the institutional experience with covered endovenous stenting in this patient population.
Main Methods:
- Retrospective review of a prospectively maintained database of patients undergoing endovenous stenting with covered stents for chronic occlusive iliocaval disease.
- Data collected over a 3-year period.
- Clinical follow-up and venous duplex assessments were performed.
Main Results:
- Ten patients underwent iliocaval stenting with a total of 33 covered stents (SECS and BECS).
- No perioperative or postoperative complications were observed.
- Primary stent patency was 90% at a median follow-up of 12.1 months.
- Significant improvement in pain, ulceration, claudication, and edema was noted in symptomatic patients.
Conclusions:
- Covered endovenous stenting is a safe and promising procedure for chronically occluded central veins.
- This technique may enhance short- and long-term outcomes in challenging venous stenting cases.
- Further research is needed to assess long-term efficacy and cost-effectiveness.
Background:
Chronic iliocaval obstruction is a challenging clinical entity to treat. Endovenous iliocaval stenting is becoming the treatment of choice for central vein stenosis and occlusion. However, outcomes in thrombotic disease have not been as robust as nonthrombotic disease. In this article, we describe our experience utilizing covered stents as a novel tool for chronic total occlusions of the iliocaval veins.
Methods:
We performed a retrospective review of a prospectively maintained database of all patients undergoing endovenous stenting with a covered stent for chronic occlusive iliocaval disease over a 3-year period at our institution. Patients were followed clinically and with venous duplexes to assess the feasibility, safety, and outcomes of iliocaval endovenous stenting with covered stents.
Results:
A total of 10 patients (8 men and 2 women) underwent iliocaval stenting with covered stents from July 2015 to May 2018. A total of 20 self-expanding covered stents (SECS) and 13 balloon expandable covered stents (BECS) were deployed in the central veins of the 10 patients. Six SECS and 5 BECS were deployed in the inferior vena cava, 10 SECS and 6 BECS were deployed in the common iliac veins (CIVs) (5 patients had bilateral CIV BECS and 2 patients had bilateral CIV SECS), and 4 SECS and 2 BECS were deployed in the external iliac veins (2 patients had bilateral SECS placed). Median follow-up time was 12.1 (range 0.5-35.0) months. There were no perioperative or postoperative complications. Nine (90%) patients maintained primary stent patency during our follow-up time. One patient (10%) had rethrombosis of his stent due to undertreated common femoral vein disease in the setting of a new myeloproliferative neoplasm and an inappropriate cessation of therapeutic anticoagulation. All patients who were symptomatic preoperatively had improvement in their pain, venous ulceration, and venous claudication. Eight of nine (89%) patients had improvement in their lower extremity edema.
Conclusions:
Covered endovenous stenting of chronically occluded central veins is a safe and promising procedure. Their use may improve the short- and long-term outcomes in this challenging patient population. Further studies are required to evaluate the long-term efficacy and cost of their use.
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