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Non obstructive iliac vein lesions and post thrombotic obstructions treated with Venovo™ and Sinus Obliquus™ stents

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    By Juan ALmeida, Medical Author and Contributor to Vein News and www. VeinsVeinsVeins.com 

    There is a burgeoning clinical interest in treating iliocaval venous obstruction with venous stents.

    I am reviewing the results of a study done by Tjun Y Tang and colleagues (see reference below) from the Department of Vascular Surgery, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, Singapore; Department of Interventional Radiology, Sengkang General Hospital, Singapore; and Department of Cardiovascular Surgery, Tainan An-nan Municipal Hospital, China Medical University.

    What was the aim of this study ?

    The aim was to determine the short-term patency and symptomatic relief gained using the Bard Venovo™ and Optimed Sinus Obliquus™ stents in the treatment of non-thrombotic iliac vein lesions (NIVL) and post-thrombotic venous obstruction (PTO). 

    What were the study methods ? 

    Retrospective review of a prospectively followed cohort. 

    What were the study methods ? 

    Sixty patients (35.0% male) with median agoe of 67 years underwent IVUS interrogation and ilio-femoral stenting from June 2018 to May 2019.

    The revised Venous Clinical Severity Score (rVCSS) was used to assess clinical outcome.

    Pain was assessed using the Visual Analogue Scale (VAS).

    The venous ulcer healing rate was also recorded.

     Patency rates were evaluated using Duplex ultrasound and computer tomography venogram.

    What were the study results ?

    Seventy-one legs were interrogated and stented.  11/60 (18.3%) patients had a bilateral procedure.

    Indications for surgery were PTO (15.5%) and NIVL (84.5%).

      PTO = post thrombotic obstruction;  NIVL = non thrombotic iliac vein lesions. 

    38.0% of the patients had CEAP 6 disease.

      CEAP 6 disease indicates presence of active venous ulcer(s). 

    The median follow-up was 283 days.

    Technical and procedural success was both 100%.

    29.6% of the treated legs had a combination of Venovo™ and Sinus Obliquus™ stents inserted for concurrent ilio-caval and iliac lesions.

    There were no major post-operative complications.

    Six month primary, assisted primary and secondary patency rates were 94.1, 97.1 and 100%, respectively.

    There were no stent fractures.

    Mean rVCSS improved from 12.26 to 4.33 at 3 months. 

    Mean VAS pain scale improved from 6.97 to 2.03 at 3 months. 

    Complete ulcer healing was seen in 27/27 (100%) patients at three months.

    What are the study conclusions ? 

    Use of Venovo™ and Sinus Obliquus™ stents for symptomatic ilio-femoral venous disease showed excellent six-month primary patency rate with no stent fractures.

    There were significant clinical improvement and low-device-related complications.

    Longer follow-up is awaited to see how these dedicated venous stents perform.

    Reference:  Tang TY, Lim Mervin Hh, Damodharan K, Yap CJq, Lee SQ, Yap HY, Chong TT, Tan J WH.  Use of the VENOVO™ and Sinus Obliquus™ venous stents in the treatment of non-thrombotic or post-thrombotic iliac vein lesions - Short-term results from a multi-centre Asian cohort.  Phlebology 2021; 36(1):70-78.