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Updated: May 10, 2025
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Endovenous bypass is an option in symptomatic patients with unsalvageable iliac vein stents
1The RANE Center for Venous & Lymphatic Diseases, Jackson, MS.
Insights
Undersized woven stents in chronic iliofemoral venous disease can occlude. This case report details a successful endovenous bypass for an occluded Wallstent, restoring venous patency and improving patient quality of life.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Venous Thromboembolism
Background:
- Stent occlusion is a complication of treating chronic iliofemoral venous disease, occurring in 3-12% of cases.
- Undersized stents, particularly woven types like Wallstent, are a contributing factor to occlusion.
- Occluded woven stents cannot be fractured and relined, necessitating alternative treatment strategies.
Purpose of the Study:
- To describe a novel endovenous bypass technique for managing an occluded, undersized iliofemoral venous stent.
- To evaluate the efficacy and safety of this bypass in restoring venous patency and improving symptoms.
Main Methods:
- A case report detailing a patient with severe symptoms due to an occluded, undersized Wallstent.
- Creation of an endovenous bypass using a Wallstent-Z stent combination around the occluded segment.
- Follow-up assessment of stent patency and patient-reported outcomes.
Main Results:
- The endovenous bypass successfully restored patency around the occluded stent.
- The patient experienced significant improvement in quality-of-life impairing symptoms.
- Patency was maintained at a nine-month follow-up.
Conclusions:
- Endovenous bypass is a viable treatment option for patients with occluded, undersized woven iliofemoral venous stents.
- This technique can effectively alleviate symptoms and restore venous function.
- Further studies are warranted to establish this approach more broadly.
Abstract:
Stent occlusion after stenting for chronic iliofemoral venous disease has an incidence of around 3% to 12% in the literature. The reasons for such occlusion vary, with patient and stent-related factors playing a role. One stent-related issue leading to stent occlusion is the use of undersized stents. Although undersized nitinol stents can be fractured and relined, this is not an option with a woven stent (eg, Wallstent). With an undersized, occluded woven stent, an option would be to bypass the occluded stent. This case report outlines the author's experience in such a setting where a patient presented with an undersized, occluded iliofemoral venous stent with severe quality-of-life impairing symptoms, and an endovenous bypass was created around the occluded stent column using Wallstent-Z stent combination. Nine months on, the patient remains significantly better with a patent stent.
