Etiology of Iliac Vein Stent Thrombosis
Anil Hingorani, enrico ascher, MD, natalie marks, md RVT.
NYU Lutheran Medical Center, Brooklyn, NY, USA.
OBJECTIVES: While correction of iliac vein stenosis is safe and efficacious,one of its major complications is iliac vein stent thrombosis.In an attempt to examine the cause or iliac vein stent thrombosis,we reviewed the location of underlying lesions encountered after thrombectomy/thrombolysis of iliac vein stents.
Methods. From February 2012 to July 2016,we performed 2228 iliac vein venograms with IVUS(1381 patients) for patients who had failed compression therapy with venous insufficiency. These were performed in our office under local anesthesia. Presenting symptom (based on CEAP): C2(21), C3(633), C4(1065), C5(269), C6(241). The mean age mean 65 ± 14 years(Range 21-99). There were 876 females. 1037 of the procedures were on left. 240 procedures of these were diagnostic. The Wallstents that were used for these non-thrombotic iliac vein stenoses ranged from 8-24 mm in diameter and 40-90 mm in length. Patients were followed up with transcutaneous duplex every 3 months for the first year and every 6-12 months thereafter. Patients were placed on Plavix for 3 months or continued their prexisting anticoagulants. Mean follow-up for this cohort was 17 months.
Results. 18 (0.8%) suffered a complete thrombosis of the iliac vein stent after a mean follow-up of 6 months (range 0-28 months) and underwent suction thrombectomy with thrombolysis. None of these patients had a prior history of DVT. No underlying lesion found was found in 1 patient. Instent restenosis was found in 11 patients. A proximal lesion was found in no patient. An external iliac vein lesion was found distal to the common iliac vein stent in 2 patients. Common femoral vein lesions were found in 6 patients. These encountered lesions were stented. All patients who underwent thrombectomy were placed on anticoagulation for 6 months. No patient was noted to suffer rethrombosis upon follow up. No correlation with stent thrombosis was encountered for age, gender, laterality, presenting symptoms, location, length or diameter of the stent.
Conclusions. In contrast to prior data suggesting that proximal lesions in the common iliac veins were an important cause of stent thrombosis, in our experience, the most common cause of stent thrombosis is instent restenosis followed by inflow lesions in the CFV. These data suggest need for ongoing surveillance of these stents. These results may be impacted by venous specific stents and routine puncture of the femoral vein to assess the CFV for stenosis.
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