Caliber-targeted reinterventional overdilation of iliac vein Wallstents

Knight, Alexander; Buck, William; May, Corbin; Jayaraj, Arjun

doi:10.1016/j.jvsv.2018.06.015

Cited by 20 publications

(10 citation statements)

References 14 publications

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“…8 Considering the status of venous intimal hyperplasia, balloon angioplasty and laser ablation have been the two most commonly used methods for ISR treatment. 20,21 In cases where…”

Section: Discussionmentioning

confidence: 99%

“…Researchers have found that fresh and organizing thrombus predominates in an early stage post stenting, and diffuse intimal thickening is found at late time points 8 . Considering the status of venous intimal hyperplasia, balloon angioplasty and laser ablation have been the two most commonly used methods for ISR treatment 20,21 . In cases where conventional balloon fails, laser ablation can provide satisfactory results, but studies have shown that about one‐third of patients after laser ablation required reintervention after a median time of 11 months.…”

Section: Discussionmentioning

confidence: 99%

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Drug‐coated balloon therapy for in‐stent restenosis in patients with iliofemoral deep vein thrombosis: A single‐arm observational study

Lei,

Pu,

Zhang

et al. 2024

Cathet Cardio Intervent

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BackgroundIliofemoral deep vein thrombosis (IFDVT) causes severe symptoms and affect the quality of life to a great extent. Endovascular thrombectomy and stent implantation have been a feasible strategie to alleviate the signs and symptoms of IFDVT. However, venous in‐stent restenosis (ISR) has become an emerging non‐negligible problem.MethodsTo evaluate the histological characteristics of venous ISR, neointima of arterial and venous ISR patients were collected and examed. To explore the effect of drug‐coated balloon (DCB) on venous ISR lesions, we conducted a single‐center retrospective case series study involving IFDVT patients with ISR after venous stenting who were treated with paclitaxel‐coated balloon dilatation.ResultsWe found a collagen‐rich matrix but not elastin, as well as fewer cells and less neovascularization in venous intimal hyperplasia compared with neointima in arteries. Thirteen IFDVT patients were involved in the study, with average preoperative stenosis degree of 87.69% ± 13.48%. After intervention, the stenosis degree was significantly reduced to 14.6% ± 14.36% immediately (p < 0.0001) and to 16.54% ± 15.73% during follow‐up (p < 0.0001). During follow‐up, the VEINES‐QOL scores (p < 0.0001), VEINES‐Sym scores (p < 0.0001), and Villalta scores (p = 0.04) of patients was improved significantly compared with those before intervention. No major adverse events were observed.ConclusionsThe use of DCB may have a positive effect in the treatment of venous ISR by targeting intimal hyperplasia. Moreover, the application of DCB dilatation in IFDVT stenting patients with ISR is deemed safe and effective.

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“…8 Considering the status of venous intimal hyperplasia, balloon angioplasty and laser ablation have been the two most commonly used methods for ISR treatment. 20,21 In cases where…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Drug‐coated balloon therapy for in‐stent restenosis in patients with iliofemoral deep vein thrombosis: A single‐arm observational study

Lei,

Pu,

Zhang

et al. 2024

Cathet Cardio Intervent

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“…Limbs with ISR initially underwent angioplasty with balloons equal to or larger than the rated diameter of the stent (eg, a 16 mm stent would undergo angioplasty with at least a 16 mm balloon). 7 If there was persistence of ISR (luminal areas below previously described normal) on interval IVUS interrogation or if the angioplasty was ineffective on account of lack of purchase on the stent wall (watermelon seeding of balloon) laser ablation of the ISR was performed. This was carried out using a 2.3 mm Spectranetics laser catheter (Spectranetics Corp, Colorado Springs, CO) supported by 8.5Fr.…”

Section: Methodsmentioning

confidence: 99%

“… 6 The treatment of ISR is angioplasty with balloons either similar to or larger than the rated diameter of the stent. 7 Although balloon angioplasty is often successful, in some cases, the ISR lesions will not be responsive to such angioplasty. To treat such recalcitrant lesions the authors resorted to use of laser ablation of the ISR using their experience in laser recanalization of occluded venous stents as a guide.…”

mentioning

confidence: 99%

Role of laser ablation in recalcitrant instent restenosis post iliofemoral venous stenting

Jayaraj

Fuller

2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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Instent restenosis (ISR) represents the most common reason for recurrent symptoms requiring reintervention in patients who have undergone venous stenting for chronic iliofemoral venous obstruction. Treatment of ISR requires stent angioplasty typically using angioplasty balloons equal to or larger than the rated diameter of the stent. At times this does not yield the required result, and in these patients, utilization of a laser catheter supported by an angled sheath is helpful to ablate the ISR or make it more amenable to repeat balloon angioplasty. The authors report their experience with this technique for 18 patients with recurrent symptoms impacting quality of life as a result of recalcitrant ISR in this retrospective review of contemporaneously entered electronic medical record data. 12 (67%) limbs underwent laser ablation only, while 6 (33%) limbs underwent additional angioplasty post laser ablation. Post intervention for ISR, at 12 months, the venous clinical severity score improved from 5 to 3.5 (P ¼ .0005) and the VAS pain score went from 7 to 5 (P ¼ .0005). At 10 months, primary patency was 87% and primary assisted patency was 100%. There were no stent occlusions. Laser ablation of recalcitrant instent restenosis in patients presenting with recurrent chronic iliac venous obstruction post iliofemoral venous stenting is a safe and effective option. Corroboration from larger studies is warranted.

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“…These thresholds have not been validated by others but have been in use for the diagnosis and stent treatment of iliac vein stenosis in our clinic for the past 6 years with good clinical correlation. 7,8 A caliber less than normal as defined is associated with peripheral venous hypertension in 76% of limbs. 9 The aim of this study is to compare the diagnostic accuracy of duplex with IVUS reference standard using the caliber method.…”

Section: Introductionmentioning

confidence: 99%

Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis

et al. 2021

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Minimum iliac vein caliber necessary to maintain normal peripheral venous pressure can be derived by the Poiseuille equation. Duplex was compared to intravascular ultrasound (IVUS) in the assessment of iliac vein stenosis in this single center retrospective study. Parallel IVUS and duplex caliber data for common iliac vein (CIV) and external iliac vein (EIV) in 382 limbs were separately compared. One or both segments were stenotic by IVUS criteria in 213 limbs. Neither segment was stenotic by IVUS in 22 limbs. Bland–Altman analyses and Passing–Bablok linear regressions were used. Duplex calibers were dimensionally smaller than corresponding IVUS images of CIV and EIV segments in Bland–Altman comparison by a mean of 54 mm2 and 34 mm2, respectively. Passing–Bablok regression suggested the difference was due to a systematic bias and not proportional. Duplex yields a smaller cross-sectional image of CIV and EIV compared to IVUS. Duplex is not a reliable diagnostic test for iliac vein stenosis.

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Caliber-targeted reinterventional overdilation of iliac vein Wallstents

Cited by 20 publications

References 14 publications

Drug‐coated balloon therapy for in‐stent restenosis in patients with iliofemoral deep vein thrombosis: A single‐arm observational study

Drug‐coated balloon therapy for in‐stent restenosis in patients with iliofemoral deep vein thrombosis: A single‐arm observational study

Role of laser ablation in recalcitrant instent restenosis post iliofemoral venous stenting

Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis

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