Combined Stent Placement Studied for Postthrombotic CTOs of the Iliofemoral Veins

January 18, 2017—Wang Ruihua, PhD, et al published findings from a study that evaluated the technical aspects and early clinical results of combined stent placement for the management of postthrombotic syndrome (PTS) in chronic total occlusions (CTOs) of the iliofemoral veins. The study is available online ahead of print in Journal of Vascular and Interventional Radiology (JVIR).

The investigators retrospectively analyzed a total of 81 consecutive patients with postthrombotic CTOs of the iliofemoral veins treated with combined stent placement in a single institution from January 2013 to December 2014. There were 37 men, 81 limbs, and 65 left limbs. The mean patient age was 57 years. The investigators are with the Department of Vascular Surgery and Vascular Center of Shanghai Jiao Tong University in Shanghai, China.

As reported in JVIR, Wallstent devices (Boston Scientific Corporation) were used for femoral inflow, and E-Luminexx stents (Bard Peripheral Vascular, Inc.) were used for iliac outflow. Technical aspects, quality of life (QOL), stent patency, and Villalta scores were recorded at follow-up. Primary, primary assisted, and secondary patency rates were estimated with Kaplan-Meier methods with the log-rank test.

The investigators found that percutaneous recanalization was successful in 77 of 81 limbs (95.1%). Stents were deployed in all iliofemoral occlusions, with two stents in 63 lesions (77.8%) lesions and three stents in 18 lesions (22.2%). Venous perforation occurred in 32 patients (37.4%) and was resolved in all cases after stent placement. Back pain occurred during balloon angioplasty (93.8%) and persisted after stent placement in 56.8% of patients. However, the symptoms were self-limiting and did not require further therapy. 

Additionally, QOL and Villalta scores were significantly improved during a median follow-up of 19 months (range, 1–38 months; P < .01). The 2-year primary, primary assisted, and secondary cumulative stent patency rates were 81.5%, 91.4%, and 93.8%, respectively.

Combined stent placement is an effective, safe, and feasible method of managing PTS in iliofemoral CTOs until commercial venous stents designed for PTS become available, concluded the investigators in JVIR.