Reconstruction of stenotic or occluded iliofemoral veins and inferior venacava using intravascular stents: Re-establishing access for future cardiaccatheterization and cardiac surgery

OBJECTIVES The study evaluated the safety and efficacy of stent reconstruct ion of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IV C). BACKGROUND Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations. METHODS Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic an d 13 were completely occluded. Although guide wires were easily passed acro ss the stenotic vessels, occluded vessels required puncture through the thr ombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation. RESULTS Following stent placement, the mean vessel diameter increased from 0.9 +/- 1.6 to 7.4 +/- 2.6 mm (p < 0.05). Twenty-one of 28 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repe at catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diame ter of 6.4 +/- 2.0 mm. Two vessels were occluded, but they were easily reca nalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented v essel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessel s (87%) remained patent at follow-up thus far. CONCLUSIONS Stenotic/obstructed IFV and IVC may be reconstructed using sten ts to re-establish venous access to the heart for future cardiac catheteriz ation and/or surgeries. (J Am Cell Cardiol 2001;37:251-7) (C) 2001 by the A merican College of Cardiology.