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A unique complication of double barrel Wallstent technique in iliac-caval stenting.

J Vasc Surg Cases Innov Tech

June 2021

The RANE Center for Venous & Lymphatic Diseases, St. Dominic Hospital, Jackson, Miss.

Article Synopsis
  • * While generally effective, this technique can lead to a long-term complication where one stent compresses the other due to a compliance mismatch, often going unnoticed without an ultrasound examination.
  • * A possible solution to alleviate this complication could involve creating a cross-fenestration between the stent barrels, reinforced by a Z stent, especially if the barrels have a short extension into the vena cava.
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Objective: Deep venous stenting has become the primary treatment option for obstructive venous disease. Precise identification and quantification of the disease as well as localization of optimal landing zones are key elements to success. Compared with venography (anteroposterior projection), intravascular ultrasound (IVUS) seems to be more sensitive in determining those parameters.

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Background: It is generally difficult to place an iliac vein stent precisely at the iliocaval junction with venographic control or even with intravascular ultrasound guidance. Furthermore, mechanical properties of the Wallstent (Boston Scientific, Marlborough, Mass) can predispose precisely placed stents to distal displacement or stent collapse. Our center has thus advocated extending Wallstents 3 to 5 cm into the inferior vena cava to prevent complications of missed proximal lesions or stent migration.

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