Is There a Difference in Patency Between Patients Undergoing Venous Stenting for Acute Deep Venous Thrombosis Following Thrombus Removal Versus Post-thrombotic Syndrome Stenoses?

Venous stenting was introduced in the 1990s and has continued to evolve to become the first-line therapy for symptomatic iliofemoral venous outflow pathology. There are several dedicated venous stents available in addition to Boston Scientific’s Wallstent and Cook’s Z-Stent. Numerous studies from tertiary referral centres, as well as industry-sponsored trials, have demonstrated the safety and efficacy of these endovascular devices for non-thrombotic iliac vein (NIVL) and post-thrombotic syndrome (PTS) lesions. Patients presenting with acute deep venous thrombosis (aDVT) may also undergo stenting following thrombus removal. The standard of care for NIVL, PTS and aDVT patients has become venography and intravascular ultrasound, and if an underlying iliofemoral stenosis is identified, a stent is placed. There is a concern that inflammation may affect the results of stenting in the aDVT population. Although endovascular stenting for acute venous diseases appears promising and safe, there is a paucity of data on efficacy in aDVT patients. There are only two industry-sponsored trials and a few publications and presentations at academic society meetings to examine. This review assesses the available results for endovascular stenting for aDVT and PTS patients, but not for NIVL.