Gsc. Oderich et al., Stent placement for treatment of central and peripheral venous obstruction: A long-term multi-institutional experience, J VASC SURG, 32(4), 2000, pp. 760-769
Citations number
21
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Purpose: The clinical success and patency of central and peripheral venous
stents in patients with symptomatic venous obstruction (SVO) were assessed.
Methods: The records of patients with SVO treated with venous stents from 1
992 to 1999 were reviewed. Demographic and procedural variables were analyz
ed to determine their-effect on clinical success, primary patency, and seco
ndary patency. Patency was determined by means of a follow-up duplex scan o
r venogram.
Results: Forty central venous (CV) and 14 peripheral venous (PV) obstructio
ns were treated in 49 patients. Sixty-five stents were placed (50 CV and 15
PV), 54 in previously unstented lesions and 11 in previously stented lesio
ns. Causes of CV lesions included catheter placement (82%), tumor compressi
on (6%), arteriovenous fistula (AVE) and no prior catheter (2%), and other
(10%). All PV lesions resulted from complications of dialysis. Indications
for CV stents included limb edema (46%), AVP malfunction (30%), both Limb e
dema and AVE malfunction (14%), and other (10%). PV stent indications mere
AVE malfunction (86%) and limb edema (14%). Thirteen CV stents indicated to
treat tumor compression (three cases), May-Thurner syndrome (one case), de
ep venous thrombosis (three cases), superior vena cava syndrome (one case),
and lower-extremity catheter-related lesions (five cases) were excluded fr
om the analysis of clinical outcome. Fifty-two stents (37 CV and 15 PV) wer
e included in the analysis of clinical outcome. All CV lesions included in
the analysis were complications of prolonged catheterization. Eighty-nine p
ercent of patients had end-stage renal disease and an AVP. Complications de
veloped in 26% of patients with PV stents and in no patients with CV stents
(P < .002). The mean follow-up period was 16 months. Sixty-two percent of
patients required a reintervention for recurrent SVO. Only 32% of the inter
ventions resulted in sustained symptomatic improvement. For CV stents, the
primary patency rate was 85%, 27%, and 9% at 3, 12, and 24 months, respecti
vely; the secondary patency rate was 91%, 71%, and 39% at 3, 12, and 24 mon
ths, respectively; and the clinical success rate was 94%, 94%, and 79%, at
3, 12, and 24 months, respectively. For PV stents, the primary patency rate
was 73%, 17% and 17% at 3, 12, and 24 months, respectively; the secondary
patency rate was 80%, 56%, and 35% at 3, 12, and 24 months, respectively; a
nd the clinical success rate was 92%, 75%, and 42% at 3, 12 and 24 months,
respectively.
Conclusion: Stents provide a temporary benefit in most patients with centra
l or peripheral upper-extremity SVO. Regular follow-up and reinterventions
are required to maintain patency and achieve long-term clinical success. St
ents used for CV lesions have higher clinical success rates than stents use
d for PV lesions. Patients with a reasonable Life expectancy or who are una
ble to return for subsequent procedures should be considered for undergoing
alternative therapy.