In the Journals

Stents show promise for treatment of iliofemoral venous outflow obstruction

In addition to demonstrating acceptable complication rates, stent placement for iliofemoral venous outflow obstruction was associated with a high technical success rate, regardless of disease pathogenesis.

“To our knowledge, this is the first meta-analysis of stent placement for the treatment of iliofemoral venous outflow obstruction,” Cardiology Today Editorial Member Michael R. Jaff, DO, medical director of the vascular center at Massachusetts General Hospital, and colleagues wrote. “Overall, results of this analysis indicate that stent placement has a high technical success rate and is effective in restoring and maintaining patency in patients with iliofemoral venous outflow obstruction because of iliac vein compression syndrome, acute [deep venous thrombosis] or [chronic post-thrombotic] occlusion.”

Michael Jaff, DO, FSCAI

Michael R. Jaff

For the systematic review and meta-analysis, the researchers included studies from Medline and Embase searches that evaluated safety or efficacy of stent placement for iliofemoral venous outflow obstruction. They culled data by disease pathogenesis, including acute thrombotic, nonthrombotic or chronic post-thrombotic. The main outcome measures were technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years.

Overall, 37 studies examining 45 treatment effects from 2,869 patients were selected.

Between the three disease pathogenesis groups, there were similar rates of technical success (range, 94%-96%), major bleeding (range, 0.3%-1.1%), pulmonary embolism (range, 0.2%-0.9%); and periprocedural mortality (range, 0.1%-0.7%). Rates of early thrombosis ranged from 1% in the nonthrombotic group to 6.8% in the chronic post-thrombotic group.

Researchers noted that publication bias was apparent for most periprocedural complication outcomes.

Furthermore, 1-year data revealed the following patency rates for the three groups:

  • nonthrombotic: primary patency, 96%; secondary patency, 99%;
  • acute thrombotic: primary patency, 87%; secondary patency, 89%; and
  • chronic post-thrombotic: primary patency, 79%; secondary patency, 94%.

The researchers added that among patients with acute deep venous thrombosis and chronic post-thrombotic syndrome, avoidance of early thrombosis and maintenance of long-term patency remain therapeutic challenges.

“We propose a mechanism for [performance goal] comparisons so that future trials of stents designed specifically for this indication may be implemented,” they wrote. – by Brian Ellis

Disclosure: Razavi reports being a co-principal investigator for the VIRTUS trial and an adviser for Abbott Vascular, Bard Peripheral, Boston Scientific, Covidien/Medtronic and Veniti. Please see the study for a full list of the authors’ relevant financial disclosures.

In addition to demonstrating acceptable complication rates, stent placement for iliofemoral venous outflow obstruction was associated with a high technical success rate, regardless of disease pathogenesis.

“To our knowledge, this is the first meta-analysis of stent placement for the treatment of iliofemoral venous outflow obstruction,” Cardiology Today Editorial Member Michael R. Jaff, DO, medical director of the vascular center at Massachusetts General Hospital, and colleagues wrote. “Overall, results of this analysis indicate that stent placement has a high technical success rate and is effective in restoring and maintaining patency in patients with iliofemoral venous outflow obstruction because of iliac vein compression syndrome, acute [deep venous thrombosis] or [chronic post-thrombotic] occlusion.”

Michael Jaff, DO, FSCAI

Michael R. Jaff

For the systematic review and meta-analysis, the researchers included studies from Medline and Embase searches that evaluated safety or efficacy of stent placement for iliofemoral venous outflow obstruction. They culled data by disease pathogenesis, including acute thrombotic, nonthrombotic or chronic post-thrombotic. The main outcome measures were technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years.

Overall, 37 studies examining 45 treatment effects from 2,869 patients were selected.

Between the three disease pathogenesis groups, there were similar rates of technical success (range, 94%-96%), major bleeding (range, 0.3%-1.1%), pulmonary embolism (range, 0.2%-0.9%); and periprocedural mortality (range, 0.1%-0.7%). Rates of early thrombosis ranged from 1% in the nonthrombotic group to 6.8% in the chronic post-thrombotic group.

Researchers noted that publication bias was apparent for most periprocedural complication outcomes.

Furthermore, 1-year data revealed the following patency rates for the three groups:

  • nonthrombotic: primary patency, 96%; secondary patency, 99%;
  • acute thrombotic: primary patency, 87%; secondary patency, 89%; and
  • chronic post-thrombotic: primary patency, 79%; secondary patency, 94%.

The researchers added that among patients with acute deep venous thrombosis and chronic post-thrombotic syndrome, avoidance of early thrombosis and maintenance of long-term patency remain therapeutic challenges.

“We propose a mechanism for [performance goal] comparisons so that future trials of stents designed specifically for this indication may be implemented,” they wrote. – by Brian Ellis

Disclosure: Razavi reports being a co-principal investigator for the VIRTUS trial and an adviser for Abbott Vascular, Bard Peripheral, Boston Scientific, Covidien/Medtronic and Veniti. Please see the study for a full list of the authors’ relevant financial disclosures.