Functional Outcomes Following Catheter-Based Iliac Vein Stent Placement

Objective Fluoroscopic-guided interventions have become a major part of the modern vascular surgeon’s practice. Imaging is typically required to safely and effectively perform both simple and complex endovascular interventions. With an ever-increasing volume of fluoroscopic-guided interventions being performed each year, the minimization of harmful radiation exposure has become of paramount concern for both patients and providers. The purpose of this study was to identify the extent of radiation exposure associated with venography and iliac vein stenting, an intervention utilized in the management of chronic venous insufficiency. Methods This was a single-center, retrospective analysis of 40 venograms performed on 29 unique patients over a three-month period. Patients with signs and symptoms of chronic venous insufficiency who failed conservative therapy underwent evaluation of the vena cava and iliofemoral veins with venography and intravascular ultrasound. Stent placement was performed if a >50% cross-sectional area or diameter reduction was identified via intravascular ultrasound. All patients were found to have non-thrombotic iliac vein lesions. All patients wore two individual film badge dosimeters – one on their chest and the other on the abdomen. The same mobile C-arm system was used for all interventions. Results There were 15 males and 14 females, with an average age of 70.6 years old (SD ± 9.5; range 53–89) and a mean body mass index of 33.9 kg/m2. Sixteen limbs had C6 disease, 10 had C4 disease, and 14 had C3 disease. Thirty-eight of the 40 procedures resulted in stent placement, with an average of 1.13 stents placed per intervention. The average fluoroscopy time was 76.5 s (SD ± 36.9; range 7.8–209.5), and the mean cumulative air kerma was 1.08 mGy (SD ± 0.55; range 0.362–2.24). Average cumulative air kerma was higher in procedures resulting >1 stent placement compared to those with placement of ≤1 stent (1.44 vs. 1.02 mGy; p = 0.04). Fluoroscopy time was also higher in procedures with >1 stent placed (120.1 vs. 68.8 s; p = 0.0004). The mean deep dose equivalent per procedure from the patient-worn abdominal badge was 0.221 mSv. Conclusion With the adjunctive use of intravascular ultrasound, iliac vein stenting can be safely and effectively performed with very low utilization of fluoroscopy, and therefore radiation exposure can be minimized for both patients and surgeons. Placement of >1 iliac vein stent resulted in higher cumulative air kerma and fluoroscopy time.

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Iliac Vein Stent Placement and the Iliocaval Confluence

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.08.097 ◽

2020 ◽

Vol 63 ◽

pp. 307-310

Author(s):

Ahmad Alsheekh ◽

Anil Hingorani ◽

Afsha Aurshina ◽

Pavel Kibrik ◽

Jesse Chait ◽

...

Keyword(s):

Stent Placement ◽

Iliac Vein

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Safety and efficacy of stenting nonthrombotic iliac vein lesions in octogenarians and nonagenarians in an office setting

Vascular ◽

10.1177/1708538117721624 ◽

2017 ◽

Vol 26 (1) ◽

pp. 70-74 ◽

Cited By ~ 4

Author(s):

Pavel Kibrik ◽

Justin Eisenberg ◽

Ahmad Alsheekh ◽

Syed Ali Rizvi ◽

Afsha Aurshina ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Stent Placement ◽

Venous Insufficiency ◽

Iliac Vein ◽

Safety And Efficacy ◽

Office Setting ◽

Venous Stenting ◽

Area Of Interest ◽

Group 2 ◽

Group 1

Objectives Treatment options for venous insufficiency are rapidly evolving in the office setting and include venography, intravascular ultrasound, and venous stenting. Non-thrombotic iliac vein lesions assessment and treatment in an office setting is currently an area of interest. The purpose of this study is to demonstrate the safety and efficacy of evaluating non-thrombotic iliac vein lesion with this office-based procedure in octogenarians and nonagenarians. Methods From January 2012 through December 2013, 300 non-thrombotic iliac vein lesion limbs in 192 patients with venous insufficiency ≥80 years old were evaluated for non-thrombotic iliac vein lesion. Patients were evaluated and treated with venography, intravascular ultrasound, and stent placement for significant lesions demonstrated by greater than 50% diameter or cross-sectional area reduction. Group 1: 168 of these patients were octogenarians; female/male ratio was 1.75:1, bilateral in 89/168 patients (53%), left sided in 131/259 limbs (51%), right sided in 128 limbs (49%), average age 83.5 ± 2.6 years (range 80–89) compared to Group 2: 24 nonagenarians; female/male was 3:1, bilateral in 17/24 patients (70%), left sided in 20/41 limbs (49%), right sided in 21/41 limbs (51%), average age 92.9 ± 2.2 years (range 90–99). Stent related outcomes were evaluated with communication to the patient within 24 h to assess post-procedure pain followed by serial iliocaval ultrasonography. Results Out of the 300 limbs evaluated, in Group 1, 86% of limbs had stents placed compared to 90% in Group 2 and 11% of both groups had two stents placed. Overall improvement in pain, edema, and ulcers was reported in 147 (59%) of octogenarians and 24 (65%) of nonagenarians. There were no surgical site infections, pseudo-aneurysms, arteriovenous fistulas, or femoral artery injuries. No patients required transfusion within three days post-operatively and there were no 30-day mortalities in both sets of patients. Conclusions Our results demonstrate that there is no statistical difference in the outcome of performing venography, intravascular ultrasound, and stent placement in an office-based setting in octogenarians and nonagenarians. Both groups maintained a similar safety profile with low morbidity and mortality. In conclusion, we believe that the treatment of non-thrombotic iliac vein lesion in an office-based setting is safe and efficacious in both groups.

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Long-Term Outcomes of Stent Placement for Symptomatic Nonthrombotic Iliac Vein Compression Lesions in Chronic Venous Disease

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2012.01.068 ◽

2012 ◽

Vol 23 (4) ◽

pp. 502-503 ◽

Cited By ~ 11

Author(s):

Seshadri Raju

Keyword(s):

Stent Placement ◽

Iliac Vein ◽

Chronic Venous Disease ◽

Venous Disease ◽

Long Term Outcomes ◽

Iliac Vein Compression

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Stenting in the common femoral vein does not increase posthrombotic syndrome or rethrombosis

European Heart Journal ◽

10.1093/eurheartj/ehab724.2044 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Krause ◽

J M J R Telayna ◽

R A Costantini ◽

J M Telayna

Keyword(s):

Stent Placement ◽

Femoral Vein ◽

Iliac Vein ◽

Female Population ◽

Common Femoral Vein ◽

Group A ◽

The Common ◽

Group B ◽

Venous Stents

Abstract Background In lower limbs deep venous thrombosis (DVT) scenario there is evidence that favours catheter guided invasive treatment. The treatment with stenting in the common femoral vein could be related with a diminished permeability in the inflow of the deep femoral vein. There is scarce data of the clinical follow up of this treatment. Purpose To analize and compare clinical and procedural outcomes in endovenous interventions that required stent placement in the common femoral vein because of residual lesion vs interventions that did no require such treatment. Methods From May 2010 to December 2020, 122 endovenous interventions were performed, within these 74 were DVT compromising the iliofemoral territory. Two groups were defined: Group A 28 (38%) that required stent placement in the common femoral vein and Group B 46 (62%) that did not required such treatment. Results Baseline characteristics were Group A vs Group B n (%) respectively: Median age 41.1±16.7 vs 40.5±18.8; female 23 (82) vs 27 (58); smoking 7 (25) vs 14 (30); cancer 1 (4) vs 7 (15); prior prolonged rest 7 (25) vs 14 (30); concomitant diagnosis of pulmonary embolism 7 (25) vs 17 (37). Within the female population 2 (7) vs 1 (2) were in puerperium; 6 (21) vs 6 (13) were under contraceptive therapy. Regarding the diagnosis of DVT 21 (75) vs 37 (80) were acute; 7 (25) vs 9 (19) were chronic. Compromised vessels were primitive iliac vein 21 (75) vs 38 (82); external iliac vein 6 (21) vs 18 (39); superficial femoral vein 11 (39) vs 8 (17); May-Thurner syndrome 14 (50) vs 20 (43). As regards the aspects of the intervention 15 (53) vs 34 (74) had a filter implanted in the inferior vena cava; thrombolytics were infused in 20 (71) vs 32 (70); manual thrombectomy was performed in 8 (27) vs 17 (37); mechanical thrombectomy 11 (39) vs 19 (41); pre dilation with balloon was performed in 22 (79) vs 39 (85); dedicated venous stents were implanted in 22 (78) vs 39 (85); not dedicated venous stents in 13 (46) vs 11 (24). Technique success was achieved in 28 (100) vs 45 (98) p=1; major bleeding occurred 0 vs 2 (4) p=0.5; rethrombosis 3 (10) vs 9 (20) p=0.25; intrahospital death 1 (4) vs 2 (4) p=1; early reintervention was needed 1 (4) vs 2 (4) p=1, radiation dose (min) 35.4±20.2 vs 30.1±17.0 p=0.2; Contrast (ml) 216.5±76.8 vs 217.3±90.8 p=0.9. During follow up (34.1±31.5 vs 22.3±16.4) image control was performed in 27 (96) vs 39 (85) p=0.23 with either doppler or chest computed tomography angiography. Post thrombotic syndrome (PTS) symptoms were classified with Villalta Score assuming that 0–4 points had no PTS, 5–9 points presented mild PTS, 10–14 points moderate PTS, >14 points severe PTS, in Group A 1 (4) presented mild PTS vs Group B 2 (4) mild PTS p=1, 1 (2) moderate PTS. Conclusions Endovenous treatment with stent placement in the common femoral vein did not required more reinterventions nor had more complications nor had more PTS that the interventions without stent placement. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Basal Characteristics Table 2. Outcomes

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