Selective iliofemoral stent placement for complex pediatric cases: a decade of institutional experience
Sulaiman Karim1,2, Edward Gayou3,4, Jonathan Gross3,4
1Texas Tech University Health Science Center School of Medicine, Lubbock, TX, USA. Sulaiman.karim@ttuhsc.edu.
Insights
Iliac vein stenting is a durable option for pediatric patients with recurrent iliofemoral venous thromboembolism. This study found high stent patency rates in children treated with iliofemoral stents after conventional therapies failed.
Area of Science:
- Vascular Surgery
- Pediatric Cardiology
- Interventional Radiology
Background:
- Pediatric iliofemoral venous thromboembolism (VTE) resistant to conventional treatments presents management challenges.
- Stent placement is an underutilized strategy for persistent pediatric VTE or stenosis.
Purpose of the Study:
- To report institutional experience with iliofemoral stenting in pediatric patients.
- To evaluate stent patency in children with recurrent iliofemoral venous thromboembolism or stenosis.
Main Methods:
- Retrospective review of 17 pediatric patients (<18 years) undergoing iliofemoral venous stenting (2012-2022).
- Data collected included demographics, VTE risk factors, symptoms, and procedural characteristics.
- Primary outcome was stent patency at interval imaging follow-up.
Main Results:
- Seventeen patients (mean age 14.6 years) with recurrent iliofemoral VTE or stenosis underwent stenting.
- Sixteen patients had May-Thurner anatomy; 14 presented with acute VTE.
- Primary patency rates were 76% at 12 months and 71% at 24 months; secondary patency was 100% at both intervals.
Conclusions:
- Iliofemoral stent placement is a durable option for pediatric VTE.
- Stenting is effective following failure of conventional treatments like venoplasty, lysis, or thrombectomy.
- Successful stent deployment achieved high patency rates in this cohort.
Background:
Pediatric iliofemoral venous thromboembolism that is resistant to conventional treatments poses significant management challenges. Stent placement represents a potentially underutilized strategy in children when stenosis or thrombosis persists intraprocedurally or recurs postoperatively, despite treatments such as venoplasty, lysis, and thrombectomy.
Objective:
This study aims to report our institutional experience with iliofemoral stenting in 17 pediatric patients with recurrent iliofemoral venous thromboembolism or stenosis.
Materials And Methods:
We performed an IRB-approved retrospective review of pediatric patients (<18 years of age) who underwent iliofemoral venous stenting for recurrent stenosis or thrombosis between January 2012 and December 2022 at a single tertiary care institution. Patient demographics, risk factors for venous thromboembolism, presenting symptoms, and procedural characteristics were recorded. The primary outcome was stent patency rates at interval imaging follow-up.
Results:
Seventeen patients with mean age of 14.6 years (range 7-17) and mean BMI of 27.7 were stented during the study period. Sixteen of 17 patients presented with evidence of May-Thurner anatomy. 14/17 patients presented with acute iliofemoral venous thromboembolism, 2/17 with chronic venous thromboembolism, and 1/17 with left lower extremity swelling without thrombosis. Seventy-three total angiographic procedures were performed, which included angioplasty, lysis, and thrombectomy, and 23 stent placements. Patients underwent an average of 3 procedures (range 1-9) over a mean of 2.8 months (range 0-17 months) prior to undergoing stent placement. Stents were deployed successfully in all patients. The median follow-up was 18 months (range, 1-77 months). Primary and secondary patency rates were 13/17 (76%) and 14/14 (100%) at 12 months and 12/17 (71%) and 14/14 (100%) at 24 months, respectively.
Conclusion:
In our experience of 17 patients, stent placement appears to be a durable option for children with iliofemoral venous thromboembolism following failure to establish vessel patency or development of recurrent thrombosis/stenosis postoperatively.
