Author: Dr. Stephen Black

Institution: Vascular Surgery, King’s College London St Thomas’ Hospital

Summary

This article explores the mid- to long-term patency of venous stents and outlines strategies to maintain the effectiveness of stents through early intervention and post-operative follow-up. By analyzing clinical data, the study identifies the primary factors leading to stent failure and strategies for extending patency. The research concludes that early monitoring and timely re-intervention are key to ensuring long-term stent success.

Key Discussion Points

1.Venous Stent Selection:

•Different stent designs are available on the market, such as open-cell stents (e.g., Zilver Vena, Venovo, Abre) and closed-cell stents (e.g., Veniti). Open-cell stents offer greater flexibility, while closed-cell designs provide higher radial force and are suitable for areas requiring greater resistance.

2.Clinical Outcomes:

•Long-term data from St Thomas’ Hospital showed a secondary patency rate of 86% over five years. Different lesion types yielded varying patency rates, with post-thrombotic syndrome (PTS) showing an 84% patency rate, non-thrombotic iliac vein lesions (NIVL) reaching 100%, and iliac femoral deep vein thrombosis (IFDVT) at 85%.

3.Re-Intervention Strategy:

•Most stent failures occur within six weeks post-procedure due to thrombosis or inflow disease. Regular monitoring and timely re-interventions can restore patency in most cases.

Case Studies

•Case 1: A 57-year-old male with iliac vein stenting showed neointimal hyperplasia two weeks post-surgery. A successful balloon angioplasty restored patency, with no restenosis observed at the one-year follow-up.

•Case 2: A 45-year-old female developed in-stent thrombosis six months post-stenting. Following re-intervention, patency was restored, and the stent remained functional during follow-up.

Conclusion

1.Early intervention, post-operative follow-up, and timely re-intervention are crucial for maintaining the long-term patency of venous stents.

2.While various stent technologies are available, patient management remains the key to long-term success.

3.Re-intervention should be considered part of ongoing stent maintenance rather than a failure, ensuring long-term outcomes through precise monitoring and intervention.

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