A systematic review of current trends in pharmacologic management after stent placement in nonthrombotic iliac vein lesions

Objective Stenting of the iliac vein is increasingly recognized as a treatment for chronic venous insufficiency (CVI). However, the pharmacologic management after stent placement is unclear. This review was conducted to illustrate recent trends in anticoagulation and antiplatelet regimens following stent placement for nonthrombotic iliac vein lesions (NIVL). Methods The MEDLINE database was searched using the term “iliac vein stent.” Retrieval of articles was limited to studies conducted on humans and published in English between 2010 and 2020. Studies were included that described iliac vein stent placement. Studies were excluded that contained fewer than 25 patients, performed procedures other than stent placement, did not specify the postoperative anticoagulant used, or treated lesions of thrombotic origin. Results 12 articles were included in this review, yielding a total of 2782 patients with a male-to-female ratio of 0.77. The predominant CEAP classification encountered was C3. The most common stent used in the included studies was the Wallstent (9/12), and the most common pharmacologic regimen was 3 months of clopidogrel (6/12). Warfarin, aspirin, cilostazol, and rivaroxaban were among other agents used. Primary stent patency ranged from 63.1 to 98.3%. There was no apparent correlation between pharmacologic agent used and stent patency or subjective patient outcomes. Conclusion Multiple different approaches are being taken to pharmacologically manage patients following stent placement for NIVL. There is no consensus on which agent is best, nor is there a formal algorithmic approach for making this decision. Additionally, the findings in this study call into question whether anticoagulation following stenting for NIVL is necessary at all, given the similar outcomes among the different agents utilized. This review underscores the potential value of undertaking a multi-institutional prospective study to determine what is the best pharmacologic therapy following venous stent placement for NIVL.

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Treatment of Nonthrombotic Iliac Vein Lesions

Seminars in Interventional Radiology ◽

10.1055/s-0041-1727101 ◽

2021 ◽

Vol 38 (02) ◽

pp. 155-159

Author(s):

Maria Joh ◽

Kush R. Desai

Keyword(s):

Stent Placement ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Venous Stasis ◽

Venous Disease ◽

Stent Patency ◽

Extrinsic Compression ◽

Low Incidence ◽

Primary Modality

AbstractNonthrombotic iliac vein lesions (NIVLs) most frequently result from extrinsic compression of various segments of the common or external iliac vein. Patients develop symptoms associated with chronic venous insufficiency (CVI); female patients may develop symptoms of pelvic venous disease. Given that iliac vein compression can be clinically silent, a thorough history and physical examination is mandatory to exclude other causes of a patient's symptoms. Venous duplex ultrasound, insufficiency examinations, and axial imaging are most commonly used to assess for the presence of a NIVL. Catheter venography and intravascular ultrasound (IVUS) are the mainstay for invasive assessment of NIVLs and planning prior to stent placement. IVUS in particular has become the primary modality by which NIVLs are evaluated; recent evidence has clarified the lesion threshold for stent placement, which is indicated in patients with moderate to severe symptoms. In appropriately selected patients, stent placement results in improved pain, swelling, quality of life, and, when present, healing of venous stasis ulcers. Stent patency is well preserved in the majority of cases, with a low incidence of clinically driven need for reintervention. In this article, we will discuss the clinical features, workup, endovascular management, and treatment outcomes of NIVL.

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Trends in Pharmacologic Management After Iliac Venous Stent Placement

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.01.010 ◽

2021 ◽

Vol 71 ◽

pp. 455-456

Author(s):

Daniel Veyg ◽

Mustafa Alam ◽

Julio Ramos ◽

Songhon Hwang ◽

Michael Marin ◽

...

Keyword(s):

Stent Placement ◽

Pharmacologic Management

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Functional Outcomes Following Catheter-Based Iliac Vein Stent Placement

Vascular and Endovascular Surgery ◽

10.1177/1538574413487443 ◽

2013 ◽

Vol 47 (5) ◽

pp. 331-334 ◽

Cited By ~ 11

Author(s):

Courtney J. Warner ◽

Philip P. Goodney ◽

Jessica B. Wallaert ◽

Brian W. Nolan ◽

Eva M. Rzucidlo ◽

...

Keyword(s):

Stent Placement ◽

Functional Outcomes ◽

Iliac Vein

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Symptomatic compression of right iliac vein after right iliac artery stent placement

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2016.10.082 ◽

2017 ◽

Vol 5 (5) ◽

pp. 735-738 ◽

Cited By ~ 4

Author(s):

Lindsay Young ◽

Jeontaik Kwon ◽

Mariano Arosemena ◽

Dawn Salvatore ◽

Paul DiMuzio ◽

...

Keyword(s):

Iliac Artery ◽

Stent Placement ◽

Iliac Vein

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Prophylactic Paclitaxel-Eluting Stent Placement Does Not Improve Covered Femoro-Popliteal Stent Patency

SSRN Electronic Journal ◽

10.2139/ssrn.3882703 ◽

2021 ◽

Author(s):

Matthew Binks ◽

Roberto Spina ◽

Rory Marples ◽

Melissa Wright ◽

Ravi Huilgol

Keyword(s):

Stent Placement ◽

Stent Patency

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Minimally Invasive Interventional Management of Gastric Outlet Obstructions

Digestive Disease Interventions ◽

10.1055/s-0038-1639335 ◽

2018 ◽

Vol 02 (01) ◽

pp. 025-032

Author(s):

Wei-Zhong Zhou ◽

Zheng-Qiang Yang

Keyword(s):

Stent Placement ◽

Balloon Dilatation ◽

Outlet Obstruction ◽

Covered Stent ◽

Clinical Consequence ◽

Endoscopic Stenting ◽

Stent Patency ◽

Ulcer Disease ◽

Recommended Treatment ◽

Uncovered Stent

AbstractGastric outlet obstruction (GOO) is a clinical consequence of any disease that produces intrinsic or extrinsic obstruction of the pyloric channel or duodenum. The most common symptoms of GOO include nausea, vomiting, abdominal pain, and weight loss. Traditionally, surgery is regarded as the standard treatment modality. However, with the development of mini-invasive technologies, fluoroscopic or endoscopic stenting and balloon dilatation have become the mainstream of the therapies. The initial recommended treatment for malignant GOO is self-expanding metal stent placement. The stent can be classified into covered and uncovered stent according to whether it is coated with a membrane. Covered stent seems to have longer stent patency, while uncovered stent has the advantage of a lower migration rate. Regarding the etiology of benign GOO, peptic ulcer disease and corrosive injury are the two main reasons. Balloon dilatation is a simple and convenient way to treat the benign GOO. Stent placement has recently been reported for the treatment of benign GOO; however, it needs further more studies to verify its effect. This article presents a concise review of current fluoroscopic or endoscopic stenting practice for malignant GOO and balloon dilatation or stenting for benign GOO.

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Transvenous Embolization and Stent Placement for an Internal Iliac Arteriovenous Fistula with Central Iliac Vein Occlusion

Journal of Vascular and Interventional Radiology ◽

10.1097/01.rvi.0000121404.46920.ce ◽

2004 ◽

Vol 15 (4) ◽

pp. 399-404 ◽

Cited By ~ 11

Author(s):

Saim Yılmaz ◽

Abdullah Erdoğan ◽

Ersin Lüleci

Keyword(s):

Arteriovenous Fistula ◽

Stent Placement ◽

Iliac Vein ◽

Transvenous Embolization ◽

Vein Occlusion ◽

Internal Iliac ◽

Iliac Vein Occlusion

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Factors Affecting Recurrent Deep Vein Thrombosis after Pharmacomechanical Thrombolysis and Left Iliac Vein Stent Placement in Patients with Iliac Vein Compression Syndrome

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.12.807 ◽

2020 ◽

Vol 31 (4) ◽

pp. 635-643 ◽

Cited By ~ 2

Author(s):

Kun Yung Kim ◽

Hong Pil Hwang ◽

Young-Min Han

Keyword(s):

Deep Vein Thrombosis ◽

Stent Placement ◽

Iliac Vein ◽

Factors Affecting ◽

Vein Thrombosis ◽

Compression Syndrome ◽

Recurrent Deep Vein Thrombosis ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome ◽

Deep Vein

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Type of anti-thrombotic therapy for venous stenting in patients with non-thrombotic iliac vein lesions does not influence the development of in-stent restenosis

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520941385 ◽

2020 ◽

Vol 35 (10) ◽

pp. 805-813 ◽

Cited By ~ 1

Author(s):

Maxwell A Tran ◽

Priya Lakhanpal ◽

Sanjiv Lakhanpal ◽

Vinay K Satwah ◽

Gaurav Lakhanpal ◽

...

Keyword(s):

Medical Records ◽

Iliac Vein ◽

Stent Patency ◽

Venous Stenting ◽

Stent Restenosis ◽

In Stent Restenosis

Background In patients receiving stents for symptomatic non-thrombotic iliac vein lesions, many clinicians prescribe anti-thrombotic medications. Whether or not anti-coagulation post-venous stenting improves stent patency is unknown. The aim of this investigation is to determine whether prophylactic post-operative anti-thrombotic therapy improves stent patency and/or prevents in-stent restenosis. Methods The medical records and venous ultrasounds for 389 patients stented for non-thrombotic iliac vein lesions were retrospectively reviewed. Patients were categorized into three anti-thrombotic regimens: Clopidogrel, Aspirin and Clopidogrel, and Apixaban or Rivaroxaban. Patients were routinely assessed for restenosis and stent patency at 6, 26, and 52 weeks and treated with anti-thrombotics for 90 days. Results Freedom from in-stent restenosis at 6, 26, and 52 weeks were Clopidogrel (91.50, 82.91, 80.95%), Aspirin and Clopidogrel (88.68, 80.03, 80.03%), and Apixaban or Rivaroxaban (91.03, 85.11, 83.18%). Primary patencies were Clopidogrel (98.77, 98.77, 98.10%), Aspirin and Clopidogrel (100, 95.74, 95.74%), and Apixaban or Rivaroxaban (98.70, 98.70, 96.71%). There were no statistically significant differences. Conclusions The type of post-operative anti-thrombotic therapy for non-thrombotic iliac vein lesions does not appear to improve stent patency or prevent the development of in-stent restenosis.

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