Barrette Louis-Xavier, McLaughlin Shaun W, Vance Ansar Z, Trerotola Scott O, Soulen Michael C, Sudheendra Deepak, Dagli Mandeep, Redmond Jonas W, Clark Timothy W I
Section of Interventional Radiology, Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA; Section of Interventional Radiology, Penn Presbyterian Medical Center, Philadelphia, PA.
Section of Interventional Radiology, Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
Ann Vasc Surg. 2020 Jul;66:370-377. doi: 10.1016/j.avsg.2020.01.104. Epub 2020 Feb 4.
The use of stents for treating central venous occlusion is well described. Limited evidence exists related to Palmaz balloon-expandable stent use in inferior vena cava (IVC) reconstruction. We analyzed patency and complication rates after IVC reconstruction using Palmaz stents.
From 2002 to 2019, 37 patients (mean age: 51 year) underwent IVC reconstruction with 68 Palmaz stents. Indications were symptomatic chronic venous obstruction in the infrarenal (n = 25) and intrahepatic (n = 12) IVC. Demographic, operative, and imaging data were evaluated. Clinical data, abdominal CT, and/or duplex ultrasound were used to determine patency at follow-up.
Restoration of caval patency was achieved in all patients, with complications in 2/37 (5.4%) patients (thrombus formation within the stent; stent embolization eight days after placement). Follow-up data were available for 27 patients. Primary patency was maintained through last follow-up in 19/27 (70%) patients (mean: 1.1 year), with successful stent redilation performed in 6 patients. Mean duration of primary-assisted patency (n = 5) was 1.2 year. Late lumen loss was (n = 13) was 40% during a mean time to follow-up of 2.0 years. Primary patency in patients with occlusion secondary to malignancy was 109 day (range: 1 day-1.0 year), whereas primary patency in patients with occlusion from other etiologies was 1.1 year (range: 2 day-5.9 year). The Kaplan-Meier analysis demonstrated primary and primary-assisted patency of 66% and 84%, respectively, at 24 and 48 months.
Palmaz balloon-expandable stents for IVC reconstruction is feasible and effective for symptomatic IVC occlusion. Risk of stent migration was low.
