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Venous Stenting After First Rib Resection: Is It Safe?

Published:October 17, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.10.021
      Venous stenting has been condemned for use prior to rib resection, based on the historical risk of stent fracture and poor long term outcomes.
      • Kreienberg P.B.
      • Chang V.V.
      • Darling 3rd, R.C.
      • Roddy S.P.
      • Paty P.S.
      • Lloyd W.E.
      • et al.
      Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter Syndrome.
      Recent series continue to show the risk of stent complications, up to 60% in a literature review by Schropp et al.
      • Schropp L.
      • de Kleijn R.J.C.M.F.
      • Vonken E.J.
      • van Laanen J.
      • Teijink J.
      • Unlu C.
      • et al.
      Multicenter case series and literature review on durability of stents in the thoracic outlet.
      However, a study by Rajendran in 2019 suggested acceptable secondary patency rates of 100% at two years, with primary patency of 55% in patients with recalcitrant lesions stented after decompression.
      • Rajendran S.
      • Cai T.Y.
      • Loa J.
      • Saha P.
      • Dubenec S.
      Early outcomes using dedicated venous stents in the upper limb of patients with venous thoracic outlet syndrome: a single centre experience.
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      References

        • Kreienberg P.B.
        • Chang V.V.
        • Darling 3rd, R.C.
        • Roddy S.P.
        • Paty P.S.
        • Lloyd W.E.
        • et al.
        Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter Syndrome.
        J Vasc Surg. 2001; 33: S100-S105
        • Schropp L.
        • de Kleijn R.J.C.M.F.
        • Vonken E.J.
        • van Laanen J.
        • Teijink J.
        • Unlu C.
        • et al.
        Multicenter case series and literature review on durability of stents in the thoracic outlet.
        J Endovasc Ther. 2022; ([Epub ahead of print])https://doi.org/10.1177/15266028221081078
        • Rajendran S.
        • Cai T.Y.
        • Loa J.
        • Saha P.
        • Dubenec S.
        Early outcomes using dedicated venous stents in the upper limb of patients with venous thoracic outlet syndrome: a single centre experience.
        CVIR Endovasc. 2019; 2: 22
        • de Boer M.
        • Shiraev T.
        • Saha P.
        • Dubenec S.
        Medium term outcomes of deep venous stenting in the management of venous thoracic outlet syndrome.
        Eur J Vasc Endovasc Surg. 2022; ([in this issue])

      Linked Article

      • Medium Term Outcomes of Deep Venous Stenting in the Management of Venous Thoracic Outlet Syndrome
        European Journal of Vascular and Endovascular Surgery
        • Preview
          Venous thoracic outlet syndrome (vTOS) is a relatively rare condition associated with significant morbidity. Its management continues to evolve, with increasing use of endovascular adjuncts, such as percutaneous thrombectomy and angioplasty, in addition to first rib resection. The utility of stenting residual venous stenotic lesions is poorly defined within the literature. This study sought to review the medium term patency rates of upper limb deep venous stenting in the management of vTOS.
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