Venous Stent Protrusion into the Inferior Vena Cava or Jailing of the Contralateral Iliac Vein Is Not Associated with Increased Incidence of Contralateral DVT

Wednesday, September 20, 2023

11:39 AM US EDT

Location: Grand Ballroom A

Introduction, Objectives, and/or Purpose: Venous stents are often extended proximally into the inferior vena cava (IVC), which may result in partial or complete coverage of the contralateral iliac vein. The purpose of this investigation was to determine if stent protrusion into the IVC or jailing of the contralateral iliac vein is associated with an increased incidence of contralateral deep vein thrombosis (DVT).

Methods: A retrospective chart review of 664 patients stented at the Center for Vascular Medicine (CVM) from 2019 – 2020 was performed. 255 patients were excluded due to incomplete data. Of the remaining 409 patients, venograms were reviewed and measurements of the degree of stent protrusion into the IVC and whether the contralateral iliac vein was jailed were obtained. Stent protrusion was defined as any stent extension into the IVC measured from the bifurcation convergence. Types of stents, stent length and diameter, vein territory covered, reintervention rates and the incidence of postoperative DVT were noted. All patients were anticoagulated with rivaroxaban for 90 days post stent implantation.

Results: From 2019-2020, 530 stents were placed in 409 patients with an average follow-up time of 12.71±8.23 months. The average number of stents utilized per patient was 1.30. Stent types were the following: 408 Venovo, 1 Wallstent. The average stent length and diameter was 15.26±1.42 and 127.72±20.04 respectively for the entire cohort. Of the stents placed, 14 (3%) did not protrude into the IVC, 316 (78%) stents protruded partially and 79 (19%) stents jailed the contralateral iliac vein. The average length of protrusion into the IVC was 12.1±5.5 mm versus 20.3±8.4 for stents that jailed the contralateral iliac vein. Overall, 13 DVTs were identified, of which 12 were ipsilateral and secondary to stent failure, and one DVT was contralateral. The overall rate of DVT post iliac vein stenting is 3.2%, and 0.2% were contralateral. There was no difference in contralateral DVT rate between jailed and partially protruding stents at one year (p=0.20). The reintervention rate was 18% in the entire cohort.

Conclusion(s): Stent protrusion or jailing in venous stenting is commonly observed. The utilization of open-cell dedicated venous stents is not associated with an increased rate of contralateral DVT formation at one year. Long-term follow-up is needed to determine if this observation will persist.

Presenting Author(s)

DN

Duy Nguyen, n/a

Research Associate
LVF, 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.

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Co-Author(s)

Levan Sulakvelidze, BS

Director of Clinical Compliance & Healthcare Delivery
Center for Vascular Medicine
Greenbelt, Maryland, 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.
KP

Karl Pappas, n/a

Research Associate
LVF, 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.
SM

Shreya Mahadevan, MD

Research Associate
LVF, 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.
Richard Kennedy, PA-C

Lakhanpal Vein Foundation
Center for Vascular Medicine
Greenbelt, Maryland, 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.
Sanjiv Lakhanpal, MD, FACS, DABVLM

President & CEO
Center for Vein Restoration
Greenbelt, MD, 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. or AVLS has reviewed / mitigated there are no relevant financial relationships with ineligible companies.
PP

Peter J. Pappas, MD

Regional Medical Director, VLM Program Director
Center For Vein Restoration
Chester, NJ, 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. or AVLS has reviewed / mitigated there are no relevant financial relationships with ineligible companies.