Venous Stents Demonstrate Durability After Pregnancy in Study

March 8, 2022—The Society for Vascular Surgery (SVS) announced the publication of a study demonstrating that iliac vein stents tolerate a gravid uterus well and a possible future pregnancy should not contraindicate their usage in the treatment of pelvic venous insufficiency (PVI).

Peter J. Pappas, MD, et al published the findings in Journal of Vascular Surgery: Venous and Lymphatic Disorders.

“The standard of care for the treatment of chronic pelvic/leg pain secondary to PVI is iliac vein stenting with or without ovarian vein embolization,” stated Dr. Pappas, who is from the Center for Vascular Medicine (CVM) in Greenbelt, Maryland, in the SVS press release. “As many women receiving this therapy are of childbearing age, we assessed stent patency and reintervention rates in women who became pregnant after undergoing iliac vein stenting.”

The SVS press release reported that the investigators reviewed data from the CVM from January 2014 to December 2020. During this period, CVM was composed of 23 centers in four states across the United States. There were 2,046 stents placed in 1,698 women.

From this cohort, information on 15 women (average age, 35 ± 4 years) with 16 iliac vein stents for PVI who had 17 pregnancies were studied. All patients were clinical-etiological-anatomical-pathophysiological (CEAP) classification 0 to 3 and 14 were nonthrombotic. The average time between stenting and pregnancy was 31 months.

In 11 of the 17 pregnancies, patients were treated with enoxaparin. None of the women carried the diagnosis of hypercoagulability.

All patients underwent a postpartum ultrasound revealing no stent-related issues complicating any of the pregnancies. One patient was lost to follow-up. In the remaining 16 pregnancies, no stent occlusions were observed at an average time of 43 ± 24 months after the pregnancy.

“A major unresolved question related to iliac vein stenting and pregnancy is in regard to the necessity of anticoagulation during and after pregnancy,” stated Dr. Pappas in the SVS press release. “The main indication for considering anticoagulation during and after pregnancy is the known increase in clotting factors during pregnancy, the increased incidence of venous thromboembolic events in pregnant women compared with nonpregnant women, and the fear of medical liability.”

SVS explained that due to the generally low risk for anticoagulation, it appears reasonable to anticoagulate pregnant patients with iliac stents who have a known hypercoaguable state; underwent stenting for thrombotic disease; and underwent stenting for nonthrombotic disease if low risk for bleeding. The SVS press release noted further that only two other peer-reviewed publications covering this topic appear in medical journals, and this study contains the largest number of patients.