Patency and Clinical Outcome After Stent Placement for Chronic Obstruction of the Inferior Vena Cava

Abstract

The endovascular approach with stent placement for chronic IVC obstruction is a safe treatment option that should be offered to patients who otherwise have little opportunity for sustained clinical improvement.

Reversal of cardiopulmonary exercise intolerance in patients with post-thrombotic obstruction of the inferior vena cava

“…In smaller case series, symptomatic patients with IVC ligation were characterized by limited increase in cardiac output during peak exercise by right heart catheterization [4], and limited peak oxygen uptake during cardiopulmonary exercise testing [7,8]. Measurements at anaerobic threshold may better reflect changes in cardiac hemodynamics in patients with initially low exercise capacity who may experience an improvement in PTS severity following endovascular intervention for two reasons: (1) many PTS patients do not fulfill the criteria of sufficient subject effort during cardiopulmonary exercise testing as confirmed by our study, (2) recanalization of the IVC is associated with improvement in PTS severity and venous claudication [10,15,16], and therefore may potentially improve peak exercise performance and VO 2 independent from cardiac effects. Of note, we also observed a trend towards lower heart rate at anaerobic threshold after IVC reconstruction, which is not explainable by a reduction in exerciseinduced venous claudication.…”

Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation

“…To account for the low rates of complications with zero events in numerous RCTs, the beta-binomial model was applied, as continuity correction should be avoided [ 16 ]. These results were confirmed by fitting a Bayesian random-effects meta-analysis to the data of the primary endpoint [ 16 , 17 ]. Even the best-case/worst-case analysis strongly supports the results of the primary analysis.…”

“…To evaluate the influence of the missing values for the main outcome, a best-case/worst-case analysis was performed as sensitivity analysis. As a second sensitivity analysis, a pooled OR with its 95% credible interval was derived by fitting a Bayesian random-effects meta-analysis to the data of the outcome pneumothorax [ 17 ]. For the treatment effect, a non-informative normal prior distribution (N(0,10^4) and for the between-studies variance, a log-normal prior distribution based on the values for the outcome category ‘surgical/device-related success/failure’ was used for this sensitivity analysis [ 18 ].…”

Comparación de permeabilidad primaria de stents venosos en segmentos cavo-ilio-femorales en pacientes con obstrucciones de etiología intrínseca y extrínseca

“…En general y de acuerdo con la literatura, existen adecuados resultados a corto y mediano plazo con la colocación de stents en las lesiones no trombóticas [12][13][14] , lo cual concuerda con nuestros resultados. Otro aspecto importante por considerar son los desafíos en el entendimiento de la hemodinámica del sistema venoso profundo, el stent debe tener suficiente fuerza para resistir la compresión externa y la fuerza radial para soportar la compresión en las patologías obstructivas compresivas como el SMT 15 . El empleo de trombólisis en los casos de trombosis aguda, previa a la colocación del stent, podría representar un sesgo, ya que se incluyeron pacientes con trombosis venosa crónica a los cuales no se podía aliviar la carga trombótica previa.…”

“…Neglen, et al 10 reportaron una tasa de oclusión intrastent en un seguimiento a 2 años del 3.2%; y todas las oclusiones sucedieron en pacientes con lesiones postrombóticas, a pesar de que en el estudio la mayoría de los pacientes presentaban lesiones no trombóticas. En un análisis de factores que podrían estar asociados con oclusiones tempranas y tardías, los autores encontraron que los stents tenían 9 veces más posibilidad de ocluirse si los pacientes tenían obstrucciones crónicas 15 .…”