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Title: Iliocaval Confluence Stenting for Chronic Venous Obstructions

Abstract

PurposeDifferent techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions.Materials and MethodsBetween 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents.ResultsRecanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7–1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency.more » In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29–337) days.ConclusionStenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.« less

Authors:
 [1];  [2];  [1]; ;  [2];  [3]
  1. Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands)
  2. Maastricht University Medical Centre (MUMC), Department of Surgery (Netherlands)
  3. University Hospital Aachen, Department of Surgery (Germany)
Publication Date:
OSTI Identifier:
22469763
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 38; Journal Issue: 5; Other Information: Copyright (c) 2015 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2015 The Author(s); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; CONTAINERS; HYBRIDIZATION; LIGAMENTS; MAGNETIC RESONANCE; PATIENTS; VEINS

Citation Formats

Graaf, Rick de, E-mail: r.de.graaf@mumc.nl, Wolf, Mark de, E-mail: markthewolf@gmail.com, Sailer, Anna M., E-mail: anni.sailer@mumc.nl, Laanen, Jorinde van, E-mail: jorinde.van.laanen@mumc.nl, Wittens, Cees, E-mail: c.wittens@me.com, and Jalaie, Houman, E-mail: hjalaie@ukaachen.de. Iliocaval Confluence Stenting for Chronic Venous Obstructions. United States: N. p., 2015. Web. doi:10.1007/S00270-015-1068-5.
Graaf, Rick de, E-mail: r.de.graaf@mumc.nl, Wolf, Mark de, E-mail: markthewolf@gmail.com, Sailer, Anna M., E-mail: anni.sailer@mumc.nl, Laanen, Jorinde van, E-mail: jorinde.van.laanen@mumc.nl, Wittens, Cees, E-mail: c.wittens@me.com, & Jalaie, Houman, E-mail: hjalaie@ukaachen.de. Iliocaval Confluence Stenting for Chronic Venous Obstructions. United States. doi:10.1007/S00270-015-1068-5.
Graaf, Rick de, E-mail: r.de.graaf@mumc.nl, Wolf, Mark de, E-mail: markthewolf@gmail.com, Sailer, Anna M., E-mail: anni.sailer@mumc.nl, Laanen, Jorinde van, E-mail: jorinde.van.laanen@mumc.nl, Wittens, Cees, E-mail: c.wittens@me.com, and Jalaie, Houman, E-mail: hjalaie@ukaachen.de. 2015. "Iliocaval Confluence Stenting for Chronic Venous Obstructions". United States. doi:10.1007/S00270-015-1068-5.
@article{osti_22469763,
title = {Iliocaval Confluence Stenting for Chronic Venous Obstructions},
author = {Graaf, Rick de, E-mail: r.de.graaf@mumc.nl and Wolf, Mark de, E-mail: markthewolf@gmail.com and Sailer, Anna M., E-mail: anni.sailer@mumc.nl and Laanen, Jorinde van, E-mail: jorinde.van.laanen@mumc.nl and Wittens, Cees, E-mail: c.wittens@me.com and Jalaie, Houman, E-mail: hjalaie@ukaachen.de},
abstractNote = {PurposeDifferent techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions.Materials and MethodsBetween 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents.ResultsRecanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7–1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency. In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29–337) days.ConclusionStenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.},
doi = {10.1007/S00270-015-1068-5},
journal = {Cardiovascular and Interventional Radiology},
number = 5,
volume = 38,
place = {United States},
year = 2015,
month =
}
  • A case of bilateral iliac stenosis and caval stenosis due to retroperitoneal fibrosis was treated by caval stenting and iliac balloon angioplasty, but was complicated by subsequent iliac thrombosis. Venous thrombectomy was successfully achieved by hydrodynamic thrombectomy, and iliac patency was stabilized by bilateral stent insertion.
  • Postoperative inferior vena cava (IVC) thrombosis is a potentially lethal complication in a liver transplant recipient. We report the case of a 57-year-old liver transplant recipient, who developed acute, postoperative, markedly symptomatic complete IVC, ilial-femoral-caval, and left renal vein thrombosis. After treatment with power-pulse tissue plasminogen activator thrombolysis, thrombectomy, and stent placement, the IVC and iliac veins were successfully recanalized. At 2.5-year imaging and laboratory follow-up, the IVC, iliac, and renal veins remained patent and graft function was preserved.
  • Purpose: To evaluate whether balloon angioplasty combined with stenting (ST) of symptomatic femoropopliteal disease would provide better results compared with balloon angioplasty alone (BA). Methods: Fifty-one patients were randomized between ST (24 patients) and BA (27 patients). Follow-up comprised clinical and hemodynamic assessment and color-flow duplex ultrasound examinations. Results: Residual stenosis ({>=} 30% diameter reduction) occurred in three BA patients, but not in the ST patients. By life-table analysis the cumulative rate of clinical and hemodynamic success after 1 year with ST was 74% (SE 9%) and for those with BA 85% (SE 7%) (p0.25). The primary patency at 1more » year assessed by color-flow duplex ultrasound was 62% (SE 9%) for ST-treated patients and 74% (SE 8%) for BA patients (p0.22). Occlusion occurred in five ST patients (21%) compared with two BA patients (7%). Conclusion: ST does not improve clinical and hemodynamic outcome compared with BA. Moreover, the occlusion rate in ST-treated patients is higher.« less
  • The objective of this study was to analyze three ureteral stenting techniques in patients with malignant ureteral obstructions, considering the indications, techniques, procedural costs, and complications. In the period between June 2003 and June 2006, 45 patients with bilateral malignant ureteral obstructions were evaluated (24 males, 21 females; average age, 68.3; range, 42-87). All of the patients were treated with ureteral stenting: 30 (mild strictures) with direct stenting (insertion of the stent without predilation), 30 (moderate/severe strictures) with primary stenting (insertion of the stent after predilation in a one-stage procedure), and 30 (mild/moderate/severe strictures with infection) with secondary stenting (insertionmore » of the stent after predilation and 2-3 days after nephrostomy). The incidence of complications and procedural costs were compared by a statistical analysis. The primary technical success rate was 98.89%. We did not observe any major complications. The minor complication rate was 11.1%. The incidence of complications for the various techniques was not statistically significantly. The statistical analysis of costs demonstrated that the average cost of secondary stenting ( Euro 637; SD, Euro 115) was significantly higher than that of procedures which involved direct or primary stenting ( Euro 560; SD, Euro 108). We conclude that one-step stenting (direct or primary) is a valid option to secondary stenting in correctly selected patients, owing to the fact that when the procedure is performed by expert interventional radiologists there are high technical success rates, low complication rates, and a reduction in costs.« less
  • We report the case of a 37-year-old man with necrotizing pancreatitis associated with inflammatory extrahepatic portal vein stenosis and progressive ascites. Four months after the acute onset, when no signs of infection were present, portal decompression was performed to treat refractory ascites. Transjugulartranshepatic venoplasty failed to dilate the stenosis in the extrahepatic portion of the portal vein sufficiently. Therefore a Wallstent was implanted, resulting in almost normal diameter of the vessel. In follow-up imaging studies the stent and the portal vein were still patent 12 months after the intervention and total resolution of the ascites was observed.