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A Comparison of Open versus Closed Cell Dedicated Venous Stents for Treatment of Chronic Iliofemoral Venous Outflow Obstruction

Research output: Contribution to journalMeeting abstract

Rachael Morris, NIcholas Jackson, Taha Khan, Adam Gwozdz, Naryan Karunanithy, Naryanan Thulasidasan, Stephen Black, Prakash Saha

Original languageEnglish
Pages (from-to)549
Number of pages550
JournalJournal of vascular surgery. Venous and lymphatic disorders
Volume9
Issue number2
PublishedMar 2021

King's Authors

Abstract

Background A number of dedicated self-expanding nitinol stents have been designed for use in the venous system with both open-cell (OC) and closed-cell (CC) designs available. Data directly comparing these devices are, however, lacking. The objective of this study was to examine outcomes in groups of patients with chronic deep venous insufficiency treated with either an open or CC venous stent at a single center. Methods A retrospective review of all patients treated with a dedicated nitinol venous stents at a vascular center between 2014 and 2019 was carried out. Patient characteristics including the indication for treatment and extent of disease were recorded. Stent patency, number and type of reintervention (lyisis, venoplasty, reinforcement, extension, arteriovenous fistula formation) between each stent design were compared in the first postoperative year. Subgroup analysis was carried out for patients who had stenting ending above the inguinal ligament versus those who required stenting across the inguinal ligament. Results A total of 206 patients were identified with 107 patients treated with CC stents and 99 with OC designs. The overall median age at intervention was 42 years (OC 42 years, CC 44 years), and 67% were female (OC 67%; CC 67%). Post-thrombotic syndrome was the indication for intervention in 73% of patients (OC 70%; CC 73%) with the remainder treated for nonthrombotic iliac vein lesions. Stenting across the inguinal ligament was required in 62% of patients (OC 55%; CC 56%). There were no significant differences in baseline demographics observed between the groups, and inflow disease (stenosis or occlusion of profunda vein and/or femoral vein) was present in 46% of patients (OC 45%; CC 47%). There were no significant difference in primary patency (OC 64%; CC 61%; P = .41) or cumulative patency (94% OC vs 92% CC; P = .57) at 12 months. There were more reinterventions for CC stents that crossed the inguinal ligament (mean, 1.2 reinterventions per patient CC versus 0.6 OC; P < .05), eight (15%) patients with CC stents across the ligament required relining of the stent system due to fracture or compression and seven (13%) of these required multiple reinterventions. This was not observed in OC stents (15% vs 0%; P < .05). Conclusions There was no overall difference in stent patency between patients treated with open versus CC venous stents for chronic deep venous insufficiency at one-year. Patients requiring stenting across the inguinal ligament had, however, fewer reinterventions when treated with a stent with an open-cell design. Larger prospective trials with extended follow-up are required to evaluate the long-term performance and durability of both of these designs and their impact on clinical outcomes.

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