Guidance of Venous Stent Implantation after Catheter-directed Thrombosis in Patients with Acute Left Lower Extremity Deep Venous Thrombosis based on Pressure Gradient Differences between the Iliac Vein and Inferior Vena Cava: A Single-center Retrospective Study

Che, H.; Liu, Guolong; Yu, Ying; Sang, Guifeng; Zhang, Xiaoming

doi:10.1016/j.avsg.2018.12.088

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…Bajwa’R et al reported accurate venous stent placement using fluoroscopy only based on the relationship between bony landmarks and predictable locations in patients with MTS ( 31 ). Other methods of using a pressure gradient or pulling the inflated balloon to feel resistance have also been reported for iliac vein stenting ( 32 , 33 ). However, the use of bony landmarks may be limited in alternative spine anatomy such as scoliosis or pedicle variants.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for stent occlusion after catheter-directed thrombolysis and iliac vein stenting in the treatment of May-Thurner syndrome with iliofemoral deep vein thrombosis: a retrospective cohort study

Kim¹,

Park²,

Hong³

et al. 2022

Quant Imaging Med Surg

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Background: This study aimed to identify the risk factors for stent occlusion in patients with iliofemoral deep vein thrombosis (DVT) secondary to May-Thurner syndrome (MTS) who underwent catheter-directed thrombolysis (CDT) and iliac vein stenting. Methods: A retrospective analysis was performed on 44 patients who underwent CDT and iliac vein stenting for MTS with iliofemoral DVT between October 2001 and March 2018. MTS was diagnosed based on extrinsic compression of the left common iliac vein (CIV) by the overlying right common iliac artery (CIA) on computed tomography (CT). Clinical records of the study population were reviewed to collect baseline data, procedural characteristics, and outcomes. Final venograms showing diffuse and irregular wall thickening in the iliofemoral vein were considered to indicate a chronic post-thrombotic lesion. The stent position was categorized as follows: confluence coverage without touching the contralateral inferior vena cava (IVC) wall, IVC extension contacting the contralateral IVC wall, or distal to the iliocaval junction.Stent patency was assessed using duplex ultrasonography. Risk factors for stent occlusion were assessed using univariate and multivariate Cox proportional hazard models. Results:The median duplex ultrasound follow-up period was 25 months (range, 1-196 months).The overall cumulative patency rate at 12 months was 70.0%. In the univariate Cox regression, factors significantly associated with stent occlusion included symptom duration >2 weeks before CDT, partial thrombolysis (50-99% of thrombus removal), chronic post-thrombotic lesions, and stent position.Multivariate Cox regression showed that chronic post-thrombotic lesions [hazard ratio (HR) =7.15; 95% confidence interval (CI): 1.32-38.81; P=0.023] and a stent distal to the iliocaval junction (HR =5.59; 95% CI: 1.46-21.38; P=0.012) were significantly associated with stent occlusion.Conclusions: Chronic post-thrombotic lesion and a stent distal to the iliocaval junction were important risk factors for stent occlusion in patients who underwent CDT and iliac vein stenting.

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Section: Discussionmentioning

confidence: 99%

“…However, the use of bony landmarks may be limited in alternative spine anatomy such as scoliosis or pedicle variants. Pressure gradient measurements can be affected by the patient’s position and respiration ( 31 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for stent occlusion after catheter-directed thrombolysis and iliac vein stenting in the treatment of May-Thurner syndrome with iliofemoral deep vein thrombosis: a retrospective cohort study

Kim¹,

Park²,

Hong³

et al. 2022

Quant Imaging Med Surg

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“…Iliac vein compression syndrome is caused by compression of the iliac vein and/or the presence of luminal adhesion that leads to venous stasis, increasing the risk of DVTs. 5 According to one study, more than 50% of patients with iliofemoral DVT suffer from venous stasis. 6 Venous stenting is becoming the treatment of choice iliofemoral venous occlusion given its high success rate and is effective in restoring and maintain patency of the venous flow.…”

Section: Discussionmentioning

confidence: 99%

Stent Embolization Mimicking Acute Myocardial Infarction

Huda

Kahlown

Pathmanathan

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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Venous thromboembolism is associated with significant morbidity and mortality if left untreated. Anticoagulation is the cornerstone of treatment. Venous stents are a relatively newer entity that are increasingly being used to treat venous stenosis/occlusion. It is a safe procedure, but complications include vein rupture, arterial puncture, retroperitoneal bleeding, and in-stent thrombosis. Stent migration is a rare but potentially fatal complication. We present a case of venous stent embolization to the heart that presented as a non-ST segment elevation myocardial infarction.

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“…Furthermore, left iliac vein compression is not necessarily pathological and has been reported to be present in 25% of the adult population, rarely leading to thrombosis. Yet, it is worth mentioning that although stent implantation simply because the left common iliac vein is stenotic should be avoided, Che et al demonstrated that stenting contributed to prolonged patency when the iliac venous pressure gradient across the area of compression was greater than 2 mmHg after continuous direct thrombolysis [10] . In this case, even after dilatation with an 8 × 40 mm balloon catheter, the pressure gradient remained 16 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

Endovascular strategy for deep vein thrombosis caused by a huge uterine myoma accompanied by May–Thurner syndrome: A case report

Maruyama

Miyamoto

2020

Radiology Case Reports

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We report the case of a 71-year-old female presenting with deep vein thrombosis (DVT) of the left lower extremity secondary to a huge uterine myoma, who was successfully managed by hysterectomy and staged endovascular treatment. Her DVT was caused by left common iliac vein compression as a result of both the huge uterine myoma and preexisting May–Thuner syndrome. Although reported to put patients at high risk for DVT, coexisting large uterine myomas and May–Thurner syndrome are considered extremely rare.

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Guidance of Venous Stent Implantation after Catheter-directed Thrombosis in Patients with Acute Left Lower Extremity Deep Venous Thrombosis based on Pressure Gradient Differences between the Iliac Vein and Inferior Vena Cava: A Single-center Retrospective Study

Cited by 7 publications

References 20 publications

Risk factors for stent occlusion after catheter-directed thrombolysis and iliac vein stenting in the treatment of May-Thurner syndrome with iliofemoral deep vein thrombosis: a retrospective cohort study

Risk factors for stent occlusion after catheter-directed thrombolysis and iliac vein stenting in the treatment of May-Thurner syndrome with iliofemoral deep vein thrombosis: a retrospective cohort study

Stent Embolization Mimicking Acute Myocardial Infarction

Endovascular strategy for deep vein thrombosis caused by a huge uterine myoma accompanied by May–Thurner syndrome: A case report

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