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Excision Of Iliac Vein Stent For Treatment Of Nickel Associated Systemic Hypersensitivity Reaction
Ryan Taylor, MD, Lauren B. Grimsley, MD MBA, Michael M. McNally, MD, Michael R. Buckley, MD.
University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
DEMOGRAPHICS: Endovascular stenting is a mainstay for treatment of common vascular occlusive disease. This is a case of a young 43 year old patient with a nickel allergy who experienced a systemic hypersensitivity reaction to a metal stent within the common iliac vein requiring stent explantation.
HISTORY: A 43-year-old woman presented with hives, multifocal urticaria, facial swelling, and malaise following placement of a nitinol containing stent in her left iliac vein for May Thurner Syndrome. Allergy workup confirmed sensitivity to nickel and her symptoms were refractory to conservative management.
PLAN: She underwent open iliac stent explanation and reconstruction of her IVC and left common iliac vein with a bovine pericardial patch as shown in images 1 and 2. The patient recovered well postoperatively with resolution of her allergy symptoms.
DISCUSSION: This case emphasizes the importance of allergy review by providers before patients undergo endovascular stent placement. Nitinol, composed of nickel and titanium, is one of the most popular materials for endovascular stents. Allergy to Nitinol is rare, however the prevalence of nickel allergies in females can be up to 17%. This case demonstrates that patients with hypersensitivity to nickel-containing venous stents can be successfully managed with stent explantation. For symptomatic patients, surgical explanation can be an effective treatment option. To our knowledge this is one of the first reported cases of metal associated hypersensitivity related to an iliac vein stent.
Image 1: Left common iliac vein stent in place with extension to the inferior vena cava with the overlying aortic bifurcation, left common iliac artery and right common iliac artery.
Image 2: Status post stent removal with bovine patch angioplasty of the left common iliac vein that extends to the inferior vena cava.
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