Internal Medicine Department, Venous Thromboembolism Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain.
Universidad Católica San Antonio, Región de Murcia, Spain.
Semin Thromb Hemost. 2024 Sep;50(6):883-893. doi: 10.1055/s-0044-1786755. Epub 2024 May 11.
Deep vein thrombosis (DVT) poses a complex challenge and often leads to postthrombotic syndrome (PTS), a debilitating complication. The emergence of venous stents offers a potential preventive avenue against this complication. This study aimed to provide consensus recommendations on the use of venous stent for DVT.
From June to July 2023, 20 internal medicine, angiology and vascular surgery, and vascular and interventional radiology experts were involved in the Delphi process. Thirty-one recommendations, categorized into three thematic areas, were rigorously evaluated: indications for stent use, stent selection and placement, and monitoring and prevention of complications. Agreement was evaluated using a Likert scale, with consensus defined as agreement by two-thirds of the participants.
Consensus was reached for 23 (74.2%) of 31 recommendations. The agreement was centered on considerations, such as stent placement in specific acute DVT scenarios, emphasizing pivotal stent characteristics. However, there were divergences in the recommended stent length to prevent migration and stent characteristics based on iliocaval bifurcation morphology. Notably, there was no consensus on whether patients with DVT caused by a major transient risk factor need more than 3 months of anticoagulation therapy or whether aspirin should be added to anticoagulant treatment after venous stenting.
These consensus recommendations offer practical insights into optimizing venous stent use to prevent PTS in DVT patients. Addressing the critical aspects of stent selection, placement, and postprocedural care, these recommendations contribute to clinical decision-making. The identified divergences underscore the importance of consensus and thus indicate the need for further investigation.
深静脉血栓形成（DVT）构成了复杂的挑战，往往导致血栓后综合征（PTS），这是一种使人衰弱的并发症。静脉支架的出现为预防这种并发症提供了一个潜在的途径。本研究旨在就 DVT 中静脉支架的使用提供共识建议。
2023 年 6 月至 7 月，20 名内科、血管内科学和血管外科学以及血管和介入放射学专家参与了 Delphi 流程。对 31 项建议进行了严格评估，这些建议分为三个主题领域：支架使用的适应证、支架选择和放置以及并发症的监测和预防。使用李克特量表评估了一致性，三分之二的参与者同意定义为共识。
31 项建议中有 23 项（74.2%）达成共识。共识集中在特定急性 DVT 情况下的支架放置等方面，强调了支架的关键特征。然而，在预防迁移所需的支架长度和基于髂股分叉形态的支架特征方面存在分歧。值得注意的是，对于由主要一过性危险因素引起的 DVT 患者是否需要超过 3 个月的抗凝治疗，或者静脉支架置入后是否应在抗凝治疗中加入阿司匹林，尚无共识。
这些共识建议为优化静脉支架在预防 DVT 患者 PTS 中的使用提供了实用的见解。解决支架选择、放置和术后护理的关键方面，这些建议有助于临床决策。确定的分歧突出了达成共识的重要性，因此表明需要进一步研究。
