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In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction

Arjun Jayaraj1, Robert Fuller1, Seshadri Raju1

  • 1The RANE Center for Venous & Lymphatic Diseases, St. Dominic Hospital, Jackson, Miss.

Journal of Vascular Surgery. Venous and Lymphatic Disorders
|June 26, 2021
PubMed

Insights

In-stent restenosis (ISR) and stent compression (SC) are common after chronic iliofemoral venous stenting but not always progressive. Reintervention is indicated by symptoms, not just measurements, with good outcomes expected.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Cardiovascular Research

Background:

  • In-stent restenosis (ISR) and stent compression (SC) are frequent complications following stenting for chronic iliofemoral venous obstruction.
  • These complications are primary drivers for reintervention, yet their detailed characteristics and outcomes post-reintervention remain underexplored.

Purpose of the Study:

  • To investigate the characteristics of ISR and SC after iliofemoral venous stenting.
  • To analyze risk factors associated with the development of ISR and SC.
  • To evaluate clinical outcomes and stent patency following reintervention for ISR and SC.

Main Methods:

  • Retrospective analysis of 578 limbs/patients undergoing unilateral iliofemoral venous stenting (2014-2018).
  • ISR and SC prevalence, onset, and progression assessed using duplex ultrasound and intravascular ultrasound.
  • Risk factor analysis and reintervention outcomes, including patency rates and clinical improvement, were evaluated.

Main Results:

  • ISR prevalence reached 74% by 3 months, while SC was noted in 80% on day 1, with both stabilizing thereafter.
  • Significant risk factors for ISR included stent inflow luminal area and shear rate; asymmetric stent sizing was a risk factor for SC.
  • 16.4% of limbs required reintervention, with significant improvements in swelling and pain scores post-reintervention. 60-month patency rates were high (70-98%).

Conclusions:

  • ISR and SC are common but not relentlessly progressive after iliofemoral venous stenting.
  • Reintervention decisions should prioritize symptomatic improvement and quality of life over arbitrary ISR/SC thresholds.
  • Reintervention yields favorable clinical outcomes and long-term stent patency; further research into shear rate's role in ISR is warranted.
Abstract

Keywords:
Deep venous obstructionLliac venous stentingLliofemoral venous obstructionMay Thurner syndromePost thrombotic syndromeVenous stenting

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