The impact of stent protrusion into the inferior vena cava or jailing of the contralateral iliac vein on the incidence of contralateral deep vein thrombosis following venous stenting.

Duy Nguyen, Karl Pappas, Shreya Mahadevan, Levan Sulakvelidze, Richard Kennedy, Gaurav Lakhanpal, Sanjiv Lakhanpal, Peter J Pappas
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引用次数: 0

Abstract

Objective: Iliac vein stenting is the standard of care for patients with pelvic venous disorders secondary to symptomatic iliac vein outflow obstruction. Venous stents are often extended proximally into the inferior vena cava (IVC) which may result in partial or complete coverage of the contralateral iliac vein. The purpose of this investigation is to determine if extension of iliac vein stents into the IVC results in increased risk of contralateral deep venous thrombosis (DVT).

Methods: We retrospectively reviewed prospectively collected data from 409 patients who underwent iliac vein stenting at the Center for Vascular Medicine (CVM) from 2019 to 2020. Stent type, covered territories, initial and follow-up consults, ultrasound and operative reports were reviewed to assess for incidence of post-implantation DVT. Patients were stratified into three groups: Iliac vein stents which protruded into the IVC, stents that completely covered the orifice of the contralateral iliac vein and those with no stent protrusion into the IVC.

Results: Out of 409 patients, the average age was 53.96 ± 13.40 years with 94 males and 315 females. All stents placed were Venovo stents and all iliac vein lesions were non-thrombotic stenoses. The average follow-up period was 14.35 ± 10.09 months. The most common territories stented were the IVC-LCIV-LEIV (n = , 74%) and the IVC-RCIV-REIV (n = , 26%). Stent protrusion and distance into the IVC in millimeters (mm) was the following: Partial protrusion (n = 314, 77%, 27.6 ± 19.1), jailing of the contralateral iliac vein (n = 78, 19%, 45.9 ± 18.6), no protrusion (n = 16, 4%). The overall DVT rate post-implantation was 0.49% (n = 2). No DVTs ipsilateral to the index stent were identified and both DVTs were contralateral DVTs. A hypercoaguable disorder was reported in 6 patients (1.5%). There were no significant differences in prevalence of contralateral DVT between the three groups. (p = .35).

Conclusion: The rate of contralateral DVTs post iliac vein stenting with Nitonol based stents is extremely low. Partial or complete coverage of the contralateral iliac vein via stenting does not result in an increased incidence of contralateral DVT in the short-term. Longer follow up is needed to determine if contralateral DVTs occur after long-term implantation.

支架突入下腔静脉或对侧髂静脉狭窄对静脉支架术后对侧深静脉血栓形成发生率的影响。
目的:髂静脉支架植入术是治疗继发于症状性髂静脉流出道阻塞的盆腔静脉疾病患者的标准疗法。静脉支架通常会向近端延伸至下腔静脉(IVC),这可能会导致部分或完全覆盖对侧髂静脉。本研究旨在确定髂静脉支架延伸至 IVC 是否会增加对侧深静脉血栓形成(DVT)的风险:我们回顾性审查了2019年至2020年期间在血管医学中心(CVM)接受髂静脉支架植入术的409名患者的前瞻性数据。回顾了支架类型、覆盖区域、初次和随访咨询、超声和手术报告,以评估植入后深静脉血栓的发生率。患者被分为三组:髂静脉支架突入内静脉、支架完全覆盖对侧髂静脉口以及支架未突入内静脉:在 409 名患者中,平均年龄为 53.96±13.40 岁,其中男性 94 人,女性 315 人。所有植入的支架均为 Venovo 支架,所有髂静脉病变均为非血栓性狭窄。平均随访时间为(14.35 ± 10.09)个月。最常见的支架区域是IVC-LCIV-LEIV(n = ,74%)和IVC-RCIV-REIV(n = ,26%)。支架突出和进入 IVC 的距离(毫米)如下:部分突出(n = 314,77%,27.6 ± 19.1),对侧髂静脉阻塞(n = 78,19%,45.9 ± 18.6),无突出(n = 16,4%)。植入后深静脉血栓的总发生率为 0.49%(n = 2)。没有发现同侧的深静脉血栓,两个深静脉血栓都是对侧深静脉血栓。有 6 名患者(1.5%)报告出现高凝状态。三组患者的对侧深静脉血栓发生率无明显差异。(P=0.35):结论:使用 Nitonol 支架进行髂静脉支架置入术后,对侧深静脉血栓的发生率极低。通过支架部分或完全覆盖对侧髂静脉在短期内不会导致对侧深静脉血栓发生率增加。要确定长期植入后是否会发生对侧深静脉血栓,还需要更长时间的随访。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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