Splanchnic Vein Reconstruction Using Dedicated Venous Stents

Wednesday, April 2, 2025

11:42 AM – 11:51 AM CT

Location: Music City Center, 208 AB

Presenting Author(s)

Floyd Summers (he/him/his)

Medical Student
University of Washington, United States

Author/Co-author(s)

GL

Gabe Li, MD

Integrated IR Resident
University of Washington, United States
Jeffrey Forris Beecham Chick, MD, MPH

Professor of Clinical Radiology
Keck School of Medicine of University of Southern California, United States
MA

Matthew Abad-Santos, MD

Assistant Professor
University of Washington, United States
EM

Eric Monroe, MD (he/him/his)

Professor
University of Wisconsin, United States
DS

David S. Shin, MD

Associate Professor
University of Southern California, United States

Purpose: To report the use of dedicated venous stents, including Venovo Venous Stent Systems (BD, Franklin Lakes, NJ, USA), and Abre Venous Stents (Medtronic, Dublin, Ireland), in the splanchnic veins.

Materials and Methods: Twenty-two patients, including 12 (54.5%) males and 10 (45.5%) females (mean age: 56.0 ± 14.2 years; range: 19-75 years), underwent splanchnic vein stent reconstruction. Presenting symptoms included abdominal pain in 12 (54.5%), ascites in 11 (50.0%), and variceal hemorrhage in six (27.3%) patients. Etiologies for splanchnic vein thrombosis were cirrhosis in eight (36.4%), hypercoagulability in six (27.3%), malignancy in five (22.7%), and idiopathic in three (13.6%) patients. Technical success was defined as deployment of a dedicated venous stent in the main portal, splenic, or mesenteric veins. Clinical success was defined as improvement in the presenting symptoms of portal hypertension.

Results: Twenty-six venous stents (mean diameter 11.1 mm ± 1.7 mm, range: 10-18 mm; mean length 81.5 mm ± 23.3 mm, range: 60-120 mm) were placed. Twenty (76.9%) Abre Venous Stents and six (23.1%) Venovo Venous Stents were used. Stented venous segments included the portal (n=19), mesenteric (n=10), and splenic (n=8) veins. Fourteen (63.6%) patients had multiple segments stented. Nine (34.6%) patients had existing TIPS, 10 (45.5%) had concurrent de novo TIPS, and one (4.5%) had direct intrahepatic portosystemic shunt creation. Technical success was achieved in 22 patients (100%). Clinical success occurred in 17 (77.3%) patients. Among those without clinical improvement, three (13.6%) patients had early stent thrombosis after 12.3 ± 0.6 days, one (4.5%) patient died from their presenting diagnosis one day after the procedure, and one (4.5%) patient was discharged to hospice for pancreatic cancer without follow-up. Adverse events occurred in six (27.3%) patients. Follow-up imaging was obtained in 19 (86.4%) patients, with a mean of 252.8 ± 308.3 days (range: 7-1091 days) from the procedure to the latest available study. Of those with follow-up imaging, primary stent patency was demonstrated in 16 (84.2%) patients. Three (13.6%) patients required reintervention, with attempted recanalization in two (66.7%) and venography without intervention in one (33.3%) patient.

Conclusion: The use of dedicated venous stents in the splanchnic veins showed high technical success (100%) with high clinical success (77.3%) and primary patency (84.2%).