Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Angiology

Background:

• Deep vein thrombosis (DVT) frequently leads to debilitating postthrombotic syndrome (PTS).
• Venous stenting is an emerging strategy to prevent PTS following DVT.
• Establishing clear guidelines for venous stent use in DVT is crucial.

Purpose of the Study:

• To develop consensus recommendations for the optimal use of venous stents in DVT patients.
• To provide guidance on stent selection, placement, and postprocedural care to prevent PTS.
• To identify areas requiring further investigation regarding venous stenting for DVT.

Main Methods:

• A Delphi process involving 20 experts in internal medicine, angiology, vascular surgery, and interventional radiology.
• Evaluation of 31 recommendations across indications, selection, placement, monitoring, and complication prevention.
• Consensus defined as agreement by two-thirds of participants, assessed via Likert scale.

Main Results:

• Consensus was achieved on 23 out of 31 (74.2%) recommendations.
• Agreement focused on stent placement in acute DVT and key stent characteristics.
• Disagreements noted regarding optimal stent length and characteristics for specific iliac vein anatomies. No consensus on anticoagulation duration or aspirin use post-stenting.

Conclusions:

• These recommendations offer practical guidance for optimizing venous stent use to prevent PTS in DVT.
• The consensus addresses critical aspects of stent selection, placement, and postprocedural care.
• Identified areas of divergence highlight the need for further research and consensus building.