SIR 2024
Venous Interventions
Cameron Overfield, MD
Resident
Mayo Clinic Florida
Financial relationships: Full list of relationships is listed on the CME information page.
Beau Toskich, MD, FSIR
Professor
Mayo Clinic Jacksonville
Financial relationships: Full list of relationships is listed on the CME information page.
Charles A. Ritchie, MD
Assistant Professor of Radiology
Mayo Clinic
Disclosure information not submitted.
Zlatko Devcic, MD
Assistant Professor of Radiology
Mayo Clinic Florida
Disclosure information not submitted.
Inferior vena cava (IVC) and iliofemoral venous reconstruction is performed with bare metal stents (BMS). There is limited data on the placement of covered stents (CS). This study evaluated the technical and clinical outcomes of CS placed during IVC and iliofemoral venous reconstruction.
Materials and Methods:
20 patients (10 males, 10 females; mean age 63 years [range: 40–80]) who underwent IVC and iliofemoral venous reconstruction from July 2011 to January 2023 with the placement of covered stents (Viabahn VBX [n=10], Viabahn [n=8], Fluency Plus [n=1], iCast [n=1]) were evaluated. Medical records and imaging were retrospectively reviewed for technical success, clinical outcomes, and complications.
Results:
12 patients with non-malignant and 8 with malignant obstruction were identified. Presenting symptoms included lower extremity edema (n=20), pain (n=18), and skin discoloration (n=12). All patients had complete occlusion or severe stenosis and 15 concurrent thrombus. Indications for covered stenting were extra radial force (n=7), extravasation (n=5), tumor invasion (n=6), to exclude neointimal hyperplasia (n=1) and an arteriovenous malformation (n=1). Two patients with non-malignant and two with malignant obstruction had CS occlusion within 6 months. In the non-malignant cohort, primary and primary assisted patency were maintained at last follow-up in 7 (median 231 days [range: 34-546]) and 2 patients (median 2,285 days [range 2,183-2,386]), respectively. One patient did not have imaging follow-up but endorsed symptomatic improvement at 7 months. In the malignant cohort, primary and primary assisted patency were maintained at last follow-up in 4 (median 30 days [range: 1-1,561]) and 2 patients (median 1,439 days [range 70-2,808]), respectively. 25% of patients with non-malignant and 38% with malignant obstruction required re-intervention. Patients demonstrated improved or resolved pain (n=9; n=5), swelling (n=10; n=6), and skin changes (n=6; n=5), respectively. All 20 were placed on long term anticoagulation (Lovenox [n=5], Xarelto [n=3], Warfarin [n=3], Eliquis [n=4]), antiplatelet therapy (aspirin (ASA) [n=1]), or both (Eliquis and ASA [n=2], Xarelto and ASA [n=1], Xarelto and clopidogrel [n=1]).
Conclusion:
IVC and iliofemoral reconstruction utilizing CS is safe with favorable patency rates. Re-intervention rates are elevated (38%) and patients require close monitoring. While BMS are the standard of care in lower extremity venous reconstruction, this large series demonstrates that CS may be considered as adjuncts when clinically required.