Stenting for chronic obstructive venous disease: A current comprehensive meta-analysis and systematic review

Abstract

Objectives: The aim of this article was to summarize the efficacy and safety of venous stents in chronic obstructive venous disease (COVD) including postthrombotic syndrome (PTS) and nonthrombotic iliac vein lesions (NIVL). Methods: We searched PubMed for case series (prospective and retrospective) that focused on venous stents in the treatment of COVD published between 1st January, 2000 and 15th July, 2014. Then, we analyzed the perioperative complications, subsequent antithrombotic treatment, clinical outcomes, and long-term patency of this procedure. Results: Overall, 1987 patients from 14 studies were included in our study. The incidence of the 30-day thrombotic events was 2.0% (4.0% in PTS vs. 0.8% in NIVL, p ¼ 0.0002). The rates of access site complications and stent migration were 1.7% and 1.3%, respectively. The incidence of retroperitoneal bleeding and contrast extravasation was 1.8%. Back pain was more common with a rate of 62.9%. With stent placement, there was a significant pain and edema relief in COVD patients and the clinical-etiology-anatomy-pathophysiology scores declined. The rate of ulcer healing was 72.1% (70.3% in PTS vs. 86.9% in NIVL, p ¼ 0.0022), and the ulcer recurrence rate was 8.7%. The primary, assisted primary, and secondary patency rates were 91.4%, 95.0%, and 97.8%, respectively, at 12 months and 77.1%, 92.3%, and 94.3%, respectively, at 36 months; however, the patency rates in PTS were lower than those in NIVL. Conclusions: Stents may be a relatively effective and safe approach for PTS and NIVL patients because of the low incidence of perioperative complications and satisfying long-term patency. Some outcomes of stents in NIVL patients may be better than those in PTS patients.

Editor's Choice – Reconstruction of the femoro-ilio-caval outflow by percutaneous and hybrid interventions in symptomatic deep venous obstruction

“…Patency rates in patients with IVCS were 90%, 100%, and 100% at 60 months and were comparable with previous studies. 2,3,4 The main patency related issues were allied to stent geometry and stent placement problems. Regarding this, future outcomes are expected to improve even more with the introduction of dedicated venous stents, as excellent results of a dedicated venous stent during 12 months follow-up already support this.…”

Intravenous pressure changes in patients with postthrombotic deep venous obstruction: results using a treadmill stress test

“…The venous clinical severity score and Villalta score were obtained by the same physician for all patients, as were general patient characteristics, such as duration of complaints and previous medical history. Patients were allocated to one of four groups according to the Villalta scale: no PTS (0-4), mild PTS (5-9), moderate PTS (10)(11)(12)(13)(14) or severe PTS (> 14 or the presence of an ulcer) [2]. This study was approved by the medical ethical review board (METC 13-2-027) and principles according to the 2013-revised declaration of Helsinki were followed.…”

“…However, residual deep venous obstruction appears to have a more prominent effect on PTS, especially when occurring in the iliac veins [8,9]. Although there is evidence that treatment of these types of obstruction by percutaneous transluminal angioplasty and stenting may be effective, little is known about the hemodynamic consequences of deep venous obstructive disease [10][11][12][13][14]. In the past, extensive research involving invasive pressure measurements was performed, with the focus on deep vein incompetence and pressure measurements in the dorsal foot veins [15,16].…”

Venous Pressure Gradient: It’s Role in Diagnosis and Treatment of Steno-Obstructions of Deep Venous System

“…More evidences in the literature showed that mild degrees of stenosis could be responsible of venous hypertension and, as a consequence, of chronic venous disease [1,[20][21][22].…”