Vena Caval and Central Venous Stenoses: Management with Palmaz Balloon-expandable Intraluminal Stents

doi:10.1016/S1051-0443(91)72285-9

Journal of Vascular and Interventional Radiology

Volume 2, Issue 2, May 1991, Pages 215-223

https://doi.org/10.1016/S1051-0443(91)72285-9 Get rights and content

Palmaz balloon-expandable intraluminal stents (BEISs) were used to treat vena caval and adjacent central venous obstructions that failed to respond to conventional balloon angioplasty. An initial series included seven patients: five had superior vena cava (SVC) syndrome due to a malignant neoplasm and/or radiation therapy, one had dialysis access–related stenosis of the subclavian vein, and one had inferior vena cava (IVC) and bilateral common iliac vein obstruction due to abdominopelvic radiation therapy for Hodgkin disease. Treatment produced clinical benefit in all seven patients. Patency was achieved with stents placed across stenoses of the SVC, IVC, and brachiocephalic and subclavian veins. One stent placed in a left common iliac vein was oval and was shown to be occluded on a follow-up computed tomographic scan, suggesting that compression between the right common iliac artery and the spine was responsible. Although caution is recommended in placement at possible compression sites, BEISs can be used to treat obstructions of the vena cava and major central veins.

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Review of the literature supporting international clinical practice guidelines on iliac venous stenting and their applicability to Australia and New Zealand practice
2024, Journal of Vascular Surgery: Venous and Lymphatic Disorders
The overall goal of this report is to provide a high-level, practical approach to managing venous outflow obstruction (VOO).
A group of vascular surgeons from Australia and New Zealand with specific interest, training, and experience in the management of VOO were surveyed to assess current local practices. The results were analyzed and areas of disagreement identified. After this, the group performed a literature review of consensus guidelines published by leading international organizations focused on the management of chronic venous disease, namely, the Society for Vascular Surgery, American Venous Forum, European Society for Vascular Surgery, American Vein and Lymphatic Society, Cardiovascular and Interventional Radiology Society of Europe, and American Heart Association. These guidelines were compared against the consensus statements obtained through the surveys to determine how they relate to Australian and New Zealand practice. In addition, selected key studies, reviews, and meta-analyses on venous stenting were discussed and added to the document. A selection of statements with >75% agreement was voted on, and barriers to the guideline's applicability were identified. The final recommendations were further reviewed and endorsed by another group of venous experts.
The document addresses two key areas: patient selection and technical aspects of venous stenting. Regarding patient selection, patients with clinically relevant VOO, a Clinical-Etiologic-Anatomic-Physiologic score of ≥3 or a Venous Clinical Severity Score for pain of ≥2, or both, including venous claudication, with evidence of >50% stenosis should be considered for venous stenting (Level of Recommendation Ib). Patients with chronic pelvic pain, deep dyspareunia, postcoital pain affecting their quality of life, when other causes have been ruled out, should also be considered for venous stenting (Level of Recommendation Ic). Asymptomatic patients should not be offered venous stenting (Level of Recommendation IIIc). Patients undergoing thrombus removal for acute iliofemoral deep vein thrombosis, in whom a culprit stenotic lesion of >50% has been uncovered, should be considered for venous stenting (Level of Recommendation Ib).
Patients with VOO have been underdiagnosed and undertreated for decades; however, in recent years, interest from physicians and industry has grown substantially. International guidelines aimed at developing standards of care to avoid undertreating and overtreating patients are applicable to Australia and New Zealand practice and will serve as an educational platform for future developments.
Australian and New Zealand Society for Vascular Surgery clinical practice guidelines on venous outflow Obstruction of the femoral-iliocaval veins
2023, Journal of Vascular Surgery: Venous and Lymphatic Disorders
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal).
This article has been retracted at the request of the Editor-in-Chief.
This clinical practice guideline has been presented as an official document of the Australian and New Zealand Society for Vascular Surgery. However, the guideline did not follow a process whereby ANZSVS endorsement could be issued, and the Society has determined that it cannot provide retrospective endorsement. The Editor-in-Chief has invited the authors to submit a revised manuscript for consideration. The revised manuscript – once submitted – will be subject to the regular review process of the journal. If the new version is accepted and published, links to the retracted article will be included.
Literature Review of Percutaneous Stenting for Palliative Treatment of Malignant Superior Vena Cava Syndrome (SVCS)
2022, Academic Radiology
To assess the efficacy and safety of percutaneous stenting for the palliative treatment of malignant superior vena cava syndrome (SVCS).
Literature review of retrospective studies was performed regarding direct procedural complications (fatal and non-fatal), clinical effectiveness, and patency rates (primary and secondary) of percutaneous transluminal stenting for the palliative treatment of malignant SVCS. Pooled rates and 95% confidence intervals were calculated for fatal complications, non-fatal complications, clinical effectiveness, primary patency, and secondary patency. Pooled rates were presented overall and by stent types (Wallstent, Nitinol stents, Steel stents and Stent Graft). Odds ratios and 95% confidence intervals were calculated to compare rates by stent type.
Overall fatal complications rate was 1.46%, 95% CI [0.91 –2.23], non-fatal complications rate was 8.28%, 95% CI [6.91 –9.83], clinical effectiveness was 90.50%, 95% CI [88.86 –91.97], primary patency rate was 86.18%, 95% CI [84.06-88.12], secondary patency rate was 94.05 %, 95% CI [91.82 –95.82]. Primary patency rate of the Wallstent group was 83.38%, 95% CI [79.34 –86.90], and significantly higher for the Nitinol group 94.87%, 95% CI [87.40 –98.60], OR = 3.67, p = 0.01, and for the Stent Graft group 96.10%, 95% CI [89.00 –99.20], OR = 4.92, p = 0.01. Secondary patency rate for the Wallstent group was 93.33%, 95% CI [88.87 –96.40] and significantly lower for the Steel group 77.42%, 95% CI [58.90 –90.41], OR = 0.25, p = 0.01.
Percutaneous stenting is a safe option for palliative treatment of patients with malignant SVCS with greater than 90% of patients experiencing immediate relief of symptoms, low rates of fatal complications (1.46%) and high patency rates (86.18% primary patency and 94.05% secondary patency).
Inferior Vena Cava Reconstruction in Symptomatic Patients Using Palmaz Stents: A Retrospective Single-Center Experience
2020, Annals of Vascular Surgery
Citation Excerpt :
Evidence comparing the long-term efficacy of different methods for stent-based reconstruction of the IVC is more limited and has generally focused on self-expanding stents (SESs) during recanalization of the iliocaval system.3–10,12–16 Data regarding experience with balloon expandable stents (BES) in treating central venous obstruction are sparse, and lower still in iliocaval applications.6,12,29,30 The increased radial strength, higher potential accuracy of placement, and lower flexibility of Palmaz BES relative to SES could allow for long patency and efficacy in relieving symptoms of IVC syndrome.31,32
The use of stents for treating central venous occlusion is well described. Limited evidence exists related to Palmaz balloon-expandable stent use in inferior vena cava (IVC) reconstruction. We analyzed patency and complication rates after IVC reconstruction using Palmaz stents.
From 2002 to 2019, 37 patients (mean age: 51 year) underwent IVC reconstruction with 68 Palmaz stents. Indications were symptomatic chronic venous obstruction in the infrarenal (n = 25) and intrahepatic (n = 12) IVC. Demographic, operative, and imaging data were evaluated. Clinical data, abdominal CT, and/or duplex ultrasound were used to determine patency at follow-up.
Restoration of caval patency was achieved in all patients, with complications in 2/37 (5.4%) patients (thrombus formation within the stent; stent embolization eight days after placement). Follow-up data were available for 27 patients. Primary patency was maintained through last follow-up in 19/27 (70%) patients (mean: 1.1 year), with successful stent redilation performed in 6 patients. Mean duration of primary-assisted patency (n = 5) was 1.2 year. Late lumen loss was (n = 13) was 40% during a mean time to follow-up of 2.0 years. Primary patency in patients with occlusion secondary to malignancy was 109 day (range: 1 day–1.0 year), whereas primary patency in patients with occlusion from other etiologies was 1.1 year (range: 2 day–5.9 year). The Kaplan-Meier analysis demonstrated primary and primary-assisted patency of 66% and 84%, respectively, at 24 and 48 months.
Palmaz balloon-expandable stents for IVC reconstruction is feasible and effective for symptomatic IVC occlusion. Risk of stent migration was low.
Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction
2017, Journal of Vascular and Interventional Radiology
To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction.
CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance.
All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days).
Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.
Iliac artery stenosis complicating iliac vein stenting in a patient with a history of radiation and cancer: Case report and literature review
2015, Annals of Vascular Surgery
Radiation-associated venous stenosis is not as well described in the literature as radiation-induced arteritis and is mainly limited to case reports. Treatment of radiation-associated venous stenosis may be challenged by the patient's comorbidities, such as cancer, compressive tumor, or secondary thrombophilia. The endovascular treatment of venous occlusions is now widespread and is usually the preferred modality. This is especially true for lesions of the iliac venous system. However, the development of arterial stenosis after iliac vein stenting has not previously been reported in the literature as a complication. We present a case of left common iliac artery stenosis developing immediately after left iliac vein stenting for stenosis that developed secondary to extensive pelvic surgery and targeted radiotherapy. This case report illustrates the challenges in treating an iliac vein stenosis in a hostile pelvis, reports a previously unidentified complication of iliac vein stenting, documents the first reported cases of using kissing balloons in an artery and adjacent venous segment, and reviews the literature in regard to iliac vein and inferior vena cava stenting in patients with a history of neoplasm and radiation treatment.

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^☆: From the Department of Radiology, Clarkson Hospital, 44th and Dewey Ave, Omaha, NE 68105 (J.D.E.); the Miami Vascular Institute, Baptist Hospital of Miami (G.J.B.); the Pittsburgh Vascular Institute, Shadyside Hospital (M.H.W.); and the Department of Radiology, Indiana University School of Medicine, Indianapolis (K.O.E.). From the 1991 SCVIR annual meeting.

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Angioplasty and EndoprosthesesVena Caval and Central Venous Stenoses: Management with Palmaz Balloon-expandable Intraluminal Stents☆

Stenosis of the vena cava: preliminary assessment of treatment with expandable metallic stents

Radiology

Gianturco expandable wire stents in the treatment of superior vena cava syndrome recurring after maximum-tolerance radiation

Cancer

Superior vena cava syndrome associated with massive thrombosis: treatment with expandable wire stents

Radiology

Gianturco stent in vena cava stenoses

Gianturco expandable wire stents in treatment of venous obstructions

Angioplasty and Endoprostheses
Vena Caval and Central Venous Stenoses: Management with Palmaz Balloon-expandable Intraluminal Stents☆