Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result Peter Neglén, MD, PhD, Kathryn.

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Presentation transcript:

Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result Peter Neglén, MD, PhD, Kathryn C. Hollis, BA, Jake Olivier, PhD, Seshadri Raju, MD Journal of Vascular Surgery Volume 46, Issue 5, Pages 979-990.e1 (November 2007) DOI: 10.1016/j.jvs.2007.06.046 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 Left panel, Transfemoral venogram shows a typical nonthrombotic iliac vein lesion (NIVL) with prestent translucency at the vessel-crossing and transpelvic collaterals. A and B, Inserts show corresponding intravascular ultrasound (IVUS) image of the left panel before and after stenting. Middle panel, Waisting of balloon during inflation by the stenosis at predilation before stent placement. Right panel, A venogram after stenting shows no stenosis or collaterals. Note that the Wallstent is placed well into the inferior vena cava to prevent retrograde migration. The stent is carried into the external iliac vein because a significant stenosis was found on IVUS at the external and internal iliac vein confluence. C and D, Inserts show before and after stenting IVUS. (a, artery; the black circle within the vein is the IVUS catheter.) Journal of Vascular Surgery 2007 46, 979-990.e1DOI: (10.1016/j.jvs.2007.06.046) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 Chronic iliofemoral thrombotic stenosis before and after stenting. The stenting is carried into the common femoral vein to ensure an adequate inflow to prevent later occlusion. Journal of Vascular Surgery 2007 46, 979-990.e1DOI: (10.1016/j.jvs.2007.06.046) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 Cumulative primary, assisted-primary, and secondary patency rates of 603 limbs after iliofemoral stenting. The lower numbers represent limbs at risk for each time interval (all standard error of the mean <10%). Journal of Vascular Surgery 2007 46, 979-990.e1DOI: (10.1016/j.jvs.2007.06.046) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 4 Cumulative primary, assisted-primary, and secondary patency rates for stented limbs with nonthrombotic iliac vein lesions (NIVL) and those with previous thrombosis. The lower numbers represent total limbs at risk for each time interval (all standard error of the mean <10%). Journal of Vascular Surgery 2007 46, 979-990.e1DOI: (10.1016/j.jvs.2007.06.046) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 5 Cumulative rates of severe in-stent restenosis (>50% narrowing) in the entire study group for limbs stented for post-thrombotic lesions (thrombotic) and for limbs stented for obstruction caused by nonthrombotic iliac vein lesions. The lower numbers represent total limbs at risk for each time interval (all standard error of the mean <10%). Journal of Vascular Surgery 2007 46, 979-990.e1DOI: (10.1016/j.jvs.2007.06.046) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 6 Cumulative sustained complete relief of pain and swelling after femoroiliocaval stenting in patients who had stent placement alone and in those with additional procedures. These curves do not reflect partial improvement only. Only limbs that had preoperative pain or swelling are shown. The lower numbers represent limbs at risk for each time interval (standard error of the mean <10%). Journal of Vascular Surgery 2007 46, 979-990.e1DOI: (10.1016/j.jvs.2007.06.046) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 7 Cumulative rate of limbs with healed ulcers in patients having stent placement alone and in those with additional procedures. Limbs with ulcers that never healed were marked as unhealed and censored at 3 months. The lower numbers represent limbs at risk for each time interval (standard error of the mean <10%). Journal of Vascular Surgery 2007 46, 979-990.e1DOI: (10.1016/j.jvs.2007.06.046) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Appendix Fig (online only) Cumulative primary, assisted-primary, and secondary patency rates in a subset of limbs stented after recanalization of post-thrombotic occlusion. The lower numbers represent total limbs at risk for each time interval (all standard error of the mean <10%). Journal of Vascular Surgery 2007 46, 979-990.e1DOI: (10.1016/j.jvs.2007.06.046) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions