J Vasc Surg Venous Lymphat Disord. 2021 Jun 23:S2213-333X(21)00304-8. doi: 10.1016/j.jvsv.2021.06.009. Online ahead of print.
ABSTRACT
OBJECTIVES: Instent restenosis (ISR) and stent compression (SC) are problems encountered following stenting for chronic iliofemoral venous obstruction (CIVO) that are responsible for a majority of reinterventions. However, characteristics of ISR and SC, in addition to outcomes following reintervention have not been explored in detail and represent the focus of this study.
METHODS: A retrospective analysis of contemporaneously entered EMR data on 578 limbs/patients with initial unilateral iliofemoral venous stents placed from 2014 to 2018 was performed. ISR was estimated from stent and flow channel diameters measured using duplex ultrasound (DUS). SC was estimated from rated stent diameter and actual stent diameter on DUS. Characteristics evaluated included onset of ISR/SC post stent placement and progression over time. Analysis was performed to evaluate risk factors for the development of ISR and SC. Outcomes following reintervention for ISR/SC were also appraised.
RESULTS: 578 limbs underwent stenting for stenotic lesions (NIVL/PTS). ISR was noted in 27% of limbs on post-intervention day 1. The prevalence of ISR increased to 74% by 3 months and stabilized thereafter. SC was noted in 80% of limbs on day 1 and plateaued. Of the variables evaluated as potential risk factors for ISR, IVUS determined stent inflow luminal area and shear rate were found to be significant. For SC, asymmetric stent sizing was a significant risk factor. Over a median follow up of 24 months, 95/578 (16.4%) limbs underwent reintervention for ISR, SC or a combination. The median time to reintervention was 11 months. There was no statistically significant difference in the degree of ISR/SC among patients who underwent reintervention versus those who did not [p>0.05]. However, there was a statistically significant difference in the grade of swelling (p=0.006) and VAS pain scores (p<0.0001) between those who underwent reintervention and those who did not. Primary, primary assisted and secondary patencies at 60 months, following reintervention for ISR was 70%, 98% and 84% respectively, and for SC was 70%, 99% and 84%.
CONCLUSIONS: While ISR and SC are both common following stenting for CIVO, neither are relentlessly progressive. Indication for reintervention must be a recurrence of symptoms with impairment of quality of life and not the percentage of ISR or degree of SC. Post reintervention good outcomes can be expected both in terms of clinical improvement and stent patency. Further study of the impact of shear rate on stent flow is required to help reduce the incidence of ISR.
PMID:34174500 | DOI:10.1016/j.jvsv.2021.06.009
