Is It Necessary to Dilate Stents in Nonthrombotic Iliac Vein Lesions?
Yuriy Ostrozhynskyy, Hoang Nguyen, Anil Hingorani, MD, Eleanora Iadgarova, NP, Natalie Marks, MD, Enrico Ascher, MD.
Total Vascular Care, Brooklyn, NY, USA.
Iliac vein stenting of NIVL (nonthrombotic iliac vein lesions) is evolving treatment option for chronic venous insufficiency. After insertion, most described protocols have stents dilated with balloon venoplasty prior to completion of procedure based upon previous arterial lesion data. We investigated whether venous stent dilatation results in significant lesion area increase.
Materials and Methods:
Over 6 months, we performed 71 venoplasties and iliac vein stentings (34 right and 37 left limbs). Average age 65.34 (range 36-99, SD±13.52), 27/20 female, male patients.
Intraoperatively, IVUS (intravascular ultrasound) used to measure and record area of stenotic lesion, lesion after stenting, and after stent dilatation in iliofemoral veins. The measurement of stenosis compared with adjacent non-stenotic veins. If >50% cross-sectional area/diameter reduction found, was treated with appropriate balloon and stent size. All stents dilated with balloon after deployment.
In 44 limbs (61.97%), increase after stent dilation, pre-dilation average area 136.16 mm2 (SD ±51.71), and post-dilation area 162.66 mm2 (SD ±55.98). In 23 limbs (32.39%), decrease in area found after dilation the stent, pre-dilation average area 179.87 mm2 (SD ±54.33) and post-dilation area 163.78 mm2 (SD ±45.10). Four limbs (5.63%) had same area pre/post dilation. No statistically significant correlation found in area response compared with age, CEAP score (2-6), gender, lesion, laterality, and lesion location. No stents had thrombosis after procedures.
Our data shows no statistically significant efficacy found in utilizing venoplasty to dilate stents after deployment. Post-stent dilation should be limited to those with suboptimal self-expansion after deployment on fluoroscopic imaging.
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