Outcomes of endovascular reconstruction of the inferior vena cava with self-expanding nitinol stents.

Sebastian, Tim; Dopheide, Jörn F.; Engelberger, Rolf P.; Spirk, David; Kucher, Nils (2018). Outcomes of endovascular reconstruction of the inferior vena cava with self-expanding nitinol stents. Journal of vascular surgery. Venous and lymphatic disorder, 6(3), pp. 312-320. Elsevier 10.1016/j.jvsv.2017.11.012

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BACKGROUND Occlusion of the inferior vena cava (IVC) often causes venous claudication, leg swelling, or skin changes. We hypothesized that the outcome of nitinol stents for endovascular reconstruction of the IVC is similar to the outcome reported for steel alloy stents. METHODS From the prospective Bern Venous Stent Registry, we investigated technical success, patency rates, and clinical outcome in consecutive patients with endovascular IVC reconstruction. During routine follow-up visits, stent patency was assessed by duplex ultrasound. Clinical outcomes were evaluated using the Bozkaya score, Villalta score, and revised Venous Clinical Severity Score. RESULTS Of the 62 patients (mean age, 46 ± 18 years), 33 (53%) patients were treated for the post-thrombotic syndrome, 17 (27%) for acute thrombosis, and 12 (19%) for nonthrombotic IVC occlusion. Technical success was achieved in 61 (98%) patients, with a mean of 4.5 ± 1.9 stents (iliac kissing stents in 84%). During follow-up (mean, 21 months), 22 (36%) underwent endovascular reintervention for symptomatic stent stenosis (13 [21%] with complete stent occlusion). Primary, primary assisted, and secondary patency rates at 24 months were 57% (95% confidence interval [CI], 50%-73%), 76% (95% CI, 65%-86%), and 87% (95% CI, 80%-95%), respectively. None developed new ulcers, and all eight patients with venous ulcers at baseline had complete healing. Twenty-nine (48%) patients showed significant clinical improvement, and another 26 (43%) were free from any symptoms or signs of venous hypertension. Patients with post-thrombotic venographic changes of the femoral veins at baseline or a history of thrombosis were more likely to lose primary patency compared with patients with normal leg inflow veins and no history of thrombosis (19 [48%] vs 3 [16%]; P = .02). CONCLUSIONS The clinical outcome of endovascular reconstruction of the IVC with nitinol stents was favorable. However, approximately one-third of the patients required reintervention to maintain stent patency, most likely because of the impaired venous inflow.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Pharmacology

UniBE Contributor:

Dopheide, Jörn Fredrik; Engelberger, Rolf Peter and Spirk, David

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2213-3348

Publisher:

Elsevier

Language:

English

Submitter:

Sariana Kiechler

Date Deposited:

14 Sep 2018 10:02

Last Modified:

20 Nov 2019 08:47

Publisher DOI:

10.1016/j.jvsv.2017.11.012

PubMed ID:

29550177

BORIS DOI:

10.7892/boris.119955

URI:

https://boris.unibe.ch/id/eprint/119955

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