A recent analysis of deep venous stent placement has determined that the procedure is safe with low rates of major complications. Published in the journal CardioVascular and Interventional Radiology, the researcher team, led by Doireann P Joyce (Galway University Hospital, Galway, Ireland), state that responsibility is placed on the operator to be aware of the risks associated with deep venous stenting, although rare, so that fully informed consent can be obtained from the patient.
In their introduction, the authors describe the development of deep venous stenting into a primary treatment modality for venous obstruction across recent decades. Largely, reported complications rates are low, and are typically based on patient case reports and single-centre cohorts, which limits the broader applicability of collected data.
Aimed to determine the incidence of major complications associated with iliocaval and iliofemoral stent placement, Joyce et al collected data from three tertiary deep venous referral centres between January 2014 and September 2023. Their focus was on major complications which included: death, major bleeding requiring transfusion, massive pulmonary embolism, any complication that required endovascular or open surgical intervention, vessel rupture, acute kidney injury requiring dialysis, stent crushing, fracture, migration, involution or erosion.
Within the nine-year study period, 1,814 patients were treated for acute or chronic deep venous pathology. Concerning the venous pathology of their cohort, 44 patients were identified as having post-thrombotic syndrome; nine with acute deep vein thrombosis (DVT); six with May-Thurner lesions with DVT; and two with phlegmasia cerulea dolens. Among these patients, 61—3.3%—experienced a major stent-related complication, the most frequent of which was reported to be stent crushing (29.5%), followed by stent fracture (16.4%) and erosion of the stent through the vessel wall (13.1%). The authors note that death was a rare event (0.2%).
“Interventionists performing these procedures must be aware of the occurrence of complications associated with stent placement to counsel patients adequately and promote avoidance through optimal procedural approach,” Joyce and colleagues write.
Speaking to Venous News, Joyce commented: “This paper, highlighting the low rate of major complications associated with deep venous stenting, is timely given the increasing number of these procedures being performed worldwide. It is essential that interventionalists remain cognisant of potential risks and audit their own outcomes at regular intervals in order to ensure compliance with international best practice.”
