A number of dedicated self expanding nitinol stents have been developed for use in the venous system, with both open cell (OC) and closed cell (CC) designs available. Data comparing these different designs are lacking. The objective of this study was to evaluate outcomes in patients treated with open and closed cells for unilateral chronic iliac vein obstruction.
A single centre retrospective cohort study was conducted, including all patients treated with a dedicated nitinol venous stent between 2014 and 2019. Stent patency and details of re-interventions (including lysis, venoplasty, reinforcement, extension, arteriovenous fistula formation) were examined in the first post-operative year. Subgroup analysis described outcomes for patients treated with OC and CC stents ending above the inguinal ligament and those who required extension into the common femoral vein. Cox regression analysis was used to identify factors associated with loss of primary patency.
A total of 207 patients were included (OC 100 patients, CC 107 patients). There was no significant difference between the groups for age (OC 42 years, CC 44 years); gender (OC and CC 67% female); presence of post-thrombotic lesions (OC 71%, CC 73%); stenting across the inguinal ligament (OC 58%, CC 56%), or presence of inflow disease (OC 49%, CC 47%). Primary and cumulative patency at 12 months were similar between groups (primary: OC 63%, CC 65%; cumulative: OC 93%, CC 90%). Patients with a CC stent across the inguinal ligament had a greater risk of needing multiple re-interventions at one year compared with those with an OC stent (odds ratio 2.84, 95% confidence interval [CI] 1.16 – 6.9) but overall, the only factor significantly associated with loss of primary patency was inflow vessel disease (hazard ratio 3.39, 95% CI 1.73 – 6.62, p < .001).
OC and CC dedicated nitinol venous stents were observed to perform similarly in terms of patency and symptom improvement at one year. Disease of the inflow vessels was the most important factor associated with a loss of stent patency irrespective of stent design.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Vascular and Endovascular Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Quality of life and economic costs associated with postthrombotic syndrome.Am J Heal Pharm. 2012; 69: 567-572
- Effect of postthrombotic syndrome on health-related quality of life after deep venous thrombosis.Arch Intern Med. 2002; 162: 1144-1148
- Long-term outcomes of deep-vein thrombosis.Arch Intern Med. 1995; 155: 1031-1037
- Prospective evaluation of health-related quality of life in patients with deep venous thrombosis.Arch Intern Med. 2005; 165: 1173-1178
- Quality of life outcomes for patients undergoing venous stenting for chronic deep venous disease.J Vasc Surg Venous Lymphat Disord. 2021; 9: 1185-1192
- “Post-thrombotic panic syndrome”: A thematic analysis of the experience of venous thromboembolism.Br J Health Psychol. 2017; 22: 8-25
- Living with a venous leg ulcer: a descriptive study of patients’experiences.J Adv Nurs. 1995; 22: 1092-1100
- Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis.Ann Intern Med. 2008; 149: 698
- The long-term clinical course of acute deep venous thrombosis.Ann Intern Med. 1996; 125: 1-7
- Prevalence and predictors for post-thrombotic syndrome 3 to 16 years after pregnancy-related venous thrombosis: a population-based, cross-sectional, case-control study.J Thromb Haemost. 2012; 10: 840-847
- Assessment of the probability of post-thrombotic syndrome in patients with lower extremity deep venous thrombosis.Sci Rep. 2018; 8: 12663
- Percutaneous recanalization of total occlusions of the iliac vein.J Vasc Surg. 2009; 50: 360-368
- Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result.J Vasc Surg. 2007; 46: 979-990
- Investigation of adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents in the iliac vein: insights into developing a better iliac vein stent.J Artif Organs. 2018; 21: 254-260
- Deep venous thrombosis associated with caval extension of iliac stents.J Vasc Surg Venous Lymphat Disord. 2017; 5: 8-17
- Device profile of the Vici venous stent for chronic iliofemoral venous obstruction recanalization: overview of its safety and efficacy.Expert Rev Med Devices. 2020; 17: 391-397
- Short-term clinical experience with a dedicated venous nitinol stent: initial results with the sinus-venous stent.Eur J Vasc Endovasc Surg. 2015; 50: 518-526
- The initial report on 1-year outcomes of the feasibility study of the VENITI VICI VENOUS STENT in symptomatic iliofemoral venous obstruction.J Vasc Surg Venous Lymphat Disord. 2018; 6: 192-200
- Venovo venous stent in the treatment of non-thrombotic or post-thrombotic iliac vein lesions – short-term results from the arnsberg venous registry.Vasa. 2019; 48: 175-180
- Placement of closed-cell designed venous stents in a mixed cohort of patients with chronic venous outflow obstructions – short-term safety, patency, and clinical outcomes.Vasa. 2018; 47: 475-481
- Two year outcome after chronic iliac vein occlusion recanalisation using the Vici Venous Stent®.Eur J Vasc Endovasc Surg. 2018; 56: 710-718
- Completeness of follow-up determines validity of study findings: results of a prospective repeated measures cohort Study.PLos One. 2015; 10: e0140817
- Self-expandable nitinol stents for the treatment of nonmalignant deep venous obstruction.Circ Cardiovasc Interv. 2020; 13: e009673
- Use of the VENOVOTM and Sinus ObliquusTM venous stents in the treatment of non-thrombotic or post-thrombotic iliac vein lesions – short-term results from a multi-centre Asian cohort.Phlebology. 2020; 36: 70-78
- Patency rates and clinical outcomes in a cohort of 200 patients treated with a dedicated venous stent.J Vasc Surg Venous Lymphat Disord. 2018; 6: 321-329
- The biomechanical impact of hip movement on iliofemoral venous anatomy and stenting for deep venous thrombosis.J Vasc Surg Venous Lymphat Disord. 2020; 8: 953-960
- What predicts outcome after recanalization of chronic venous obstruction: hemodynamic factors, stent geometry, patient selection, anticoagulation or other factors?.Phlebology. 2014; 29: 97-103
- Patency and clinical outcome after stent placement for chronic obstruction of the inferior vena cava.Eur J Vasc Endovasc Surg. 2017; 54: 620-628
- Outcomes of endovascular reconstruction of the inferior vena cava with self-expanding nitinol stents.J Vasc Surg Venous Lymphat Disord. 2018; 6: 312-320
- Venous stenting across the inguinal ligament.J Vasc Surg. 2008; 48: 1255-1261
- Clinical outcomes of stenting extending below the inguinal ligament for treatment of chronic iliofemoral venous obstruction.Ann Vasc Surg. 2021; 75: 259-266
- Endovascular treatment of post-thrombotic venous ilio-femoral occlusions: prognostic value of venous lesions caudal to the common femoral vein.Cardiovasc Intervent Radiol. 2019; 42: 1117-1127
- Usefulness of direct computed tomography venography in predicting inflow for venous reconstruction in chronic post-thrombotic syndrome.Cardiovasc Intervent Radiol. 2019; 42: 677-684
- Stent extension into a single inflow vessel is a valuable option after endophlebectomy.Phlebology. 2018; 33: 610-617
- Reinterventions for nonocclusive iliofemoral venous stent malfunctions.J Vasc Surg. 2009; : 49511-49518
- Relevance of flexibility versus radial force in rigid versus more flexible venous stents?.Phlebology. 2019; 34: 459-465
- Braided or laser-cut self-expanding nitinol stents for the common femoral vein in patients with post-thrombotic syndrome.J Vasc Surg Venous Lymphat Disord. 2020; 9: 760-769
Published online: January 10, 2022
Accepted: October 19, 2021
Received: February 8, 2021
© 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Importance of Venous Inflow: Emergence of the Invisible GorillaEuropean Journal of Vascular and Endovascular SurgeryVol. 63Issue 4
- PreviewDeep venous interventions and the development of new devices to improve outcome have gained popularity rapidly in recent years. In the paper by Morris et al.1 in this issue of the journal, the authors have attempted to further scrutinise this interesting field, more specifically venous stenting. They tried this by focusing on the type of venous stent, which is an understandable approach. The single most important variable in deep venous interventions since the pioneering work of Neglen and Raju2 in the early years of the twenty first century is the “dedicated” venous stent.