Placement of closed-cell designed venous stents in a mixed cohort of patients with chronic venous outflow obstructions - short-term safety, patency, and clinical outcomes.

Background: To evaluate the performance of a closed-cell designed venous stent for the treatment of chronic ilio-femoral venous outflow obstruction (VOO) in the shortterm.

Patients And Methods: Safety, stent patency and clinical outcome after placement of the Vici Venous Stent® in patients with chronic ilio-femoral venous obstruction were assessed retrospectively. Stent patency was evaluated by duplex ultrasound scanning, and clinical outcome was determined using the revised Venous Clinical Severity score (rVCSS).

The initial report on 1-year outcomes of the feasibility study of the VENITI VICI VENOUS STENT in symptomatic iliofemoral venous obstruction.

Objective: The objective of this study was to assess the safety and efficacy of a dedicated venous stent (the VICI VENOUS STENT; VENITI, Fremont, Calif) for treatment of symptomatic iliofemoral venous outflow obstruction.

Methods: Thirty patients (24 female; median age, 43 years) were enrolled in the feasibility phase of an international, multicenter investigational device exemption trial from June 2014 to February 2015. All patients exhibited unilateral venous disease with ≥50% stenosis in the iliofemoral veins.

Multicenter assessment of venous reflux by duplex ultrasound.

Objective: This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test.

Methods: Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position.

Diagnosis and treatment of venous lymphedema.

Background: Chronic venous disease (CVD) is a common cause of secondary lymphedema. Venous lymphedema is sometimes misdiagnosed as primary lymphedema and does not receive optimal treatment. We have routinely used intravascular ultrasound (IVUS) imaging in all cases of limb swelling.

Stenting of chronically obstructed inferior vena cava filters.

Objectives: A protective inferior vena cava (IVC) filter may later be incorporated into a chronic postthrombotic ilio-caval obstruction (occlusive, requiring recanalization, or nonocclusive). This study aims to assess the safety and stent-related outcome following stenting across an obstructed filter.

Methods: From 1997 to 2009, 708 limbs had stenting for postthrombotic ilio-caval outflow obstruction (occlusion in 121 limbs).

Iliac vein stenting in postmenopausal leg swelling.

Background: Leg swelling in menopausal women is well known. Prevailing concept in primary care is that it is polycentric and a treatable cause may not be found. Patients are placed on empiric diuretics often without benefit.

Bilateral stenting at the iliocaval confluence.

Objective: This study describes three techniques of stent placement at the iliocaval confluence for chronic nonmalignant obstruction and its stent-related outcome.

Methods: From 1997 to 2008, 115 patients (230 limbs) underwent bilateral stenting for iliocaval obstruction. All limbs were CEAP classified using clinical examination and duplex ultrasound study.

Unexpected major role for venous stenting in deep reflux disease.

Background: Treatment of chronic venous insufficiency (CVI) has largely focused on reflux. Minimally-invasive techniques to address superficial and perforator reflux have evolved, but correction of deep reflux continues to be challenging. The advent of intravascular ultrasound (IVUS) scan and minimally invasive venous stent technology have renewed interest in the obstructive component in CVI pathophysiology.

Iliac-caval stenting in the obese.

Background: Chronic venous insufficiency (CVI) in the obese, often with severe clinical manifestations, is increasingly encountered in clinical practice. The association has drawn special interest as the pathophysiology may be different from that seen in the non-obese. The disease poses special management problems in the obese as traditional conservative measures are seldom effective.

Percutaneous recanalization of total occlusions of the iliac vein.

Background: Venovenous bypass has been the standard in relieving chronic total occlusions of iliac veins. The technical feasibility of percutaneous recanalization was previously reported. Routine applicability of this technique in a wide spectrum of lesions and patients, stent patency, and clinical outcome forms the basis of this presentation.

Stents for chronic venous insufficiency: why, where, how and when--a review.

Venous stenting has introduced a minimally invasive and safe technique that can be performed on an outpatient basis with little downtime for the patient. It is applicable in a wide spectrum of patients with chronic venous disease with disabling symptoms. Long-term patency and clinical outcome are excellent even when associated reflux is present and left untreated.

Reinterventions for nonocclusive iliofemoral venous stent malfunctions.

Background: Percutaneous iliofemoral venous stenting has been shown to be effective, safe, and durable in both nonthrombotic iliac vein lesion (NIVL) and postthrombotic disease. A small fraction of stented limbs require reintervention to correct stent malfunction. This manuscript examines the reasons for reintervention, types of procedures performed, and outcome.

Venous stenting across the inguinal ligament.

Background: Arterial stenting across joints is not recommended because of increased risk of in-stent focal neointimal hyperplasia and compression or fracture of the stent by joint motion with decreased long-term patency. The aim of this study was to assess the risk of placing stents in the venous system across the inguinal ligament.

Materials And Methods: From 1997 to 2006, 177 limbs with chronic non-malignant obstructive lesions had stents placed in the iliofemoral venous outflow across the inguinal ligament into the common femoral vein.

Chronic deep venous obstruction: definition, prevalence, diagnosis, management.

Ilio-caval venous obstruction has an important role in the expression of symptomatic chronic venous disease regardless of aetiology. The presence of obstruction has been more or less previously ignored and emphasis placed on reflux alone. Stenting of the ilio-femoral veins guided by intravascular ultrasound (IVUS) can now be performed with low morbidity and mortality using appropriate technique.

Secondary chronic venous disorders.

Secondary chronic venous disorders (CVD) usually follow an episode of acute deep venous thrombosis (DVT). Most occluded venous segments recanalize over the first 6 to 12 months after an episode of acute DVT, leading to chronic luminal changes and a combination of partial obstruction and reflux. Such morphological changes produce venous hypertension with the highest levels of ambulatory venous pressure occurring in patients with combined outflow obstruction and distal reflux.

Use of compression stockings in chronic venous disease: patient compliance and efficacy.

Compressive stockings are considered the centerpiece of treatment in chronic venous disease (CVD). It is known that stockings fail in some patients for varied reasons: they are ineffective despite wear in some, but more commonly patients are unable or unwilling to use them as prescribed. Detailed statistics regarding stocking compliance have not been available except in a few selected series focused on leg ulcers.

Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result.

Background: Stenting of chronic nonmalignant obstruction in the venous outflow tract started in earnest in 1997. Data sets are now available to perform long-term analysis of stent-related outcome and clinical and hemodynamic results of this intervention.

Materials: From 1997 to 2005, 982 chronic nonmalignant obstructive lesions of the femoroiliocaval vein were stented under intravascular ultrasound guidance.

Chronic venous obstruction: diagnostic considerations and therapeutic role of percutaneous iliac stenting.

Iliac venous outflow obstruction has an important role in the expression of symptomatic chronic venous insufficiency. This anatomic obstruction is frequently overlooked, owing in part to diagnostic difficulty. The combination of venous obstruction and reflux leads to more severe clinical disease.

Combined saphenous ablation and iliac stent placement for complex severe chronic venous disease.

Background: Severe chronic venous disease frequently has a complex pathophysiology. This study describes results after combined interventions to correct outflow obstruction and superficial reflux, even in the presence of deep venous reflux.

Methods: Between 1997 and 2005, 99 limbs in 96 patients had percutaneous iliofemoral venous stenting combined with great saphenous vein (GSV) stripping (39 limbs), or percutaneous GSV ablation performed by radiofrequency (27 limbs) or laser (33 limbs).