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Abstracts

Session: Global Abstracts - Tuesday 2:30 PM

A Systematic Review and Meta-analysis of 24-month Patency After Endovenous Intervention for Upper Extremity and Central Vein Stenosis

Tuesday, September 19, 2023
2:30 PM – 2:40 PM US EDT
Location: Grand Ballroom A
Introduction, Objectives, and/or Purpose: There has been sustained shift toward endovenous stenting for the treatment of symptomatic upper extremity and central vein obstruction. The purpose of this systematic review and meta-analysis was to assess the outcomes of this treatment in patients with upper extremity and central vein thrombosis or malignancy.

Methods: MEDLINE and EMBASE were searched for studies evaluating the effectiveness of central vein and upper extremity venous stent placement up to September 2020. Data were extracted by disease pathogenesis: thrombotic or malignant stenosis. Main outcomes included technical success, stent patency at 4-time intervals up to 24mths, and symptom relief. Patency rates were pooled using the meta package in R. Subgroup analysis was performed to compare outcomes between superior vena cava syndrome (SVCS) and upper extremity venous stenosis, and between patients where the obstruction was malignant or thrombotic in origin.

Results: A total of 57 studies reporting outcomes in 2558 patients were included in the meta-analysis. There were no periprocedural deaths. Pooled primary and cumulative patency are presented in Table 1. Primary patency was significantly higher for SVCS compared with upper extremity venous stenosis at 6-12mths (77%, 95% CI 67-84; N=17 vs 48%, 95% CI 36-60; N=32; P< 0.001). Additionally, primary patency was significantly higher in patients with a malignant stenosis compared with thrombosis at 6-12mths (78%; 95% CI 67-86 0.67; N=11 vs 52; 95% CI 41-63; N=38; P< 0.001). No difference was observed in cumulative patency between SVCS and upper extremity venous stenosis, or between malignant and thrombotic subgroups. We were unable to compare symptoms before and after intervention due to inconsistency in the use of validated tools and reporting

Conclusion(s): Primary patency was higher for patients undergoing stent placement for SVCS compared with upper extremity venous stenosis, and in those patients with a malignant rather than thrombotic obstruction at 6-12mths. However, venous stenting in all groups was associated with good cumulative patency at 24mhts. Venous stenting of the upper extremity and central veins may be an effective treatment for both malignant and thrombotic stenosis, however the data remain sparse and further work is necessary.

    Presenting Author(s)

  • Benedict Turner, MBChB BSc FHEA MRCS

    Clinical Research Fellow
    Academic Section of Vascular Surgery, Charing Cross Hospital, Department of Surgery and Cancer, Imperial College London
    London, United Kingdom

    Disclosure(s):

    The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • SC

    Shreya Chawla, MBBS

    Doctor
    Academic Department of Vascular Surgery, St. Thomas' Hospital, London UKAcademic Department of Vascular Surgery, St. Thomas' Hospital, London UK, United States

    Disclosure(s):

    The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.

  • Adam M. Gwozdz, MD PhD

    Clinical Lecturer in Vascular Surgery
    Imperial College London
    Imperial College London
    London, England, United Kingdom

    Disclosure(s):

    The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose. or AVLS has reviewed / mitigated there are no relevant financial relationships with ineligible companies.

    PDF
  • LT

    Laura Tincknell, MBBS

    Doctor
    Academic Department of Vascular Surgery, St. Thomas' Hospital, London UK, United States

    Disclosure(s):

    The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.

  • QZ

    Qingwei Zhang, MBBS

    Doctor
    Academic Department of Vascular Surgery, St. Thomas' Hospital, London UK, United States

    Disclosure(s):

    The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.

  • Stephen Black, MD

    Vascular Surgeon and Professor of Venous Surgery
    Kings College London and Guy’s and St Thomas’ Hospital
    Kings College London
    London, England, United Kingdom

    Disclosure(s): BSCI: Consultant/Advisory Board, Other Research Support, Research Grant; Gore: Consultant/Advisory Board; Medtronic: Consultant/Advisory Board, Other Research Support; Phillips: Consultant/Advisory Board, Other Research Support