Objective
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.
Methods
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.
Results
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).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 10, 2022
Accepted:
October 19,
2021
Received:
February 8,
2021
Identification
Copyright
© 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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.
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