MANAGEMENT OF PELVIC VENOUS STENOSIS WITH INTRAVASCULAR STAINLESS-STEEL STENTS

Patients with gynecologic malignancies may develop stenosis of the lar ge pelvic veins as a result of their disease or its treatment. The per cutaneous insertion of a stainless steel vascular stent is a novel app roach to the management of an extrinsically compressed vein. The objec tive of this study was to review the results of treating lower extremi ty edema secondary to a pelvic venous stenosis through the percutaneou s insertion of a stainless steel vascular stent. A retrospective revie w was performed on gynecologic oncology patients who presented with an edematous lower extremity and underwent an evaluation to diagnose pro ximal venous stenosis. The evaluation included sonography, venography, and balloon angioplasty prior to the percutaneous insertion of a stai nless steel vascular stent. If a venous thrombosis was documented, thr ombolysis with urokinase was performed prior to evaluation for venous stenosis. Records were reviewed for the etiology of the venous stenosi s, the location and type of stent inserted, and the ability of the ste nt to maintain patency and provide symptomatic relief. Patency was eva luated at 1-week and then at 1-, 3-, and 6-month intervals. The probab ility of vascular stent patency was calculated using life table analys is. Ten patients with cervical (n = 4), corpus (n = 3), ovarian (n = 1 ), vulvar (n = 1), and vaginal (n = 1) cancer had one or more vascular stents inserted for the treatment of a stenosed pelvic vein. The etio logies of venous stenosis were radiation fibrosis and surgery (n = 5), postoperative fibrosis (n = 3), and metastatic tumor (n = 2). The ste nted vessels were the left common (n = 5) or left external (n = 4) ili ac veins, the right common (n = 1) or right external (n = 3) iliac vei ns, and the right common femoral vein (n = 1). The median follow-up wa s 21 months. All patients had subjective resolution of their edematous extremity while the stents were patent. The interval probability of p atency of stented veins was greater than 85% at each evaluation interv al. Patency was 100% for patients beyond 6 months of follow-up. There were no major complications. The percutaneous intravascular insertion of a stainless steel stent was safe and subjectively effective in the management of venous stenosis associated with a gynecologic cancer. A prospective trial with objective endpoints may be warranted. (C) 1995 Academic Press, Inc.