The Implication of Full Metal Jacket for Iliac Vein Stenting
Pavel Kibrik, DO, Ahmad Alsheekh, MD, Samson Ferm, MD, Justin Eisenberg, DO, Natalie Marks, MD, Anil Hingorani, MD, Enrico Ascher, MD.
Total Vascular Care, brooklyn, NY, USA.
Objective: One evolving therapy for chronic venous insufficiency (CVI) is iliac vein stenting. Longer lesions may require multiple stents and implications of this practice have not been explored. We hypothesize that multiple stents would result in higher rates of early in-stent thrombosis.
Methods:In this observational study, we analyzed data for 477 patients with CVI who underwent iliac vein stenting from August 2012 to September 2014. 82 patients were identified who received two stents placed in the common iliac and external iliac veins, with a minimum length of 6cm each and obtaining more than 80 percent coverage (full metal jacket) of the iliac veins. Patients were categorized as Caucasian, Black or Hispanic. These 82 patients were compared to patients who received one stent. The two groups were compared based on age, gender, race, CEAP score, degree of stenosis, postoperative thrombosis and pain score. Pain score was obtained immediately post-operatively on a Likert scale of 0-10. Follow-up duplex was obtained within 30 days. Statistical analysis was performed using Chi-square, student's T-test and multivariate logistical regression.
Results:The average age of those receiving one stent was 67.3 years compared to 70.4 years in those receiving full metal jacket iliac vein stenting. Male gender was a significant predictor of treatment with two stents compared to female gender (p=0.006). There was a significant difference (p<0.001) in degree of stenosis for those receiving two stents (70.0%) compared to subjects receiving one stent (67.4%). In multivariate logistic analysis, gender and degree of stenosis remained independent predictors of treatment with two stents. There were no significant differences in ethnicity, CEAP score, pain score, or in-stent thrombosis between the two groups.
Conclusion:Full metal jacket iliac vein stenting is independently associated with male gender and higher degree of stenosis. In our study, full metal jacket stenting was not associated with higher incidence of early in-stent thrombosis. It appears to be a safe treatment of iliac vein stenosis.
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