Stent placement for treatment of central and peripheral venous obstruction: A long-term multi-institutional experience

Purpose: The clinical success and patency of central and peripheral venous stents in patients with symptomatic venous obstruction (SVO) were assessed. Methods: The records of patients with SVO treated with venous stents from 1992 to 1999 were reviewed. Demographic and procedural variables were analyzed to determine their-effect on clinical success, primary patency, and secondary patency. Patency was determined by means of a follow-up duplex scan or venogram. Results: Forty central venous (CV) and 14 peripheral venous (PV) obstructions were treated in 49 patients. Sixty-five stents were placed (50 CV and 15 PV), 54 in previously unstented lesions and 11 in previously stented lesions. Causes of CV lesions included catheter placement (82%), tumor compression (6%), arteriovenous fistula (AVE) and no prior catheter (2%), and other (10%). All PV lesions resulted from complications of dialysis. Indications for CV stents included limb edema (46%), AVP malfunction (30%), both Limb edema and AVE malfunction (14%), and other (10%). PV stent indications mere AVE malfunction (86%) and limb edema (14%). Thirteen CV stents indicated to treat tumor compression (three cases), May-Thurner syndrome (one case), deep venous thrombosis (three cases), superior vena cava syndrome (one case), and lower-extremity catheter-related lesions (five cases) were excluded from the analysis of clinical outcome. Fifty-two stents (37 CV and 15 PV) were included in the analysis of clinical outcome. All CV lesions included in the analysis were complications of prolonged catheterization. Eighty-nine percent of patients had end-stage renal disease and an AVP. Complications developed in 26% of patients with PV stents and in no patients with CV stents (P < .002). The mean follow-up period was 16 months. Sixty-two percent of patients required a reintervention for recurrent SVO. Only 32% of the interventions resulted in sustained symptomatic improvement. For CV stents, the primary patency rate was 85%, 27%, and 9% at 3, 12, and 24 months, respectively; the secondary patency rate was 91%, 71%, and 39% at 3, 12, and 24 months, respectively; and the clinical success rate was 94%, 94%, and 79%, at 3, 12, and 24 months, respectively. For PV stents, the primary patency rate was 73%, 17% and 17% at 3, 12, and 24 months, respectively; the secondary patency rate was 80%, 56%, and 35% at 3, 12, and 24 months, respectively; and the clinical success rate was 92%, 75%, and 42% at 3, 12 and 24 months, respectively. Conclusion: Stents provide a temporary benefit in most patients with central or peripheral upper-extremity SVO. Regular follow-up and reinterventions are required to maintain patency and achieve long-term clinical success. Stents used for CV lesions have higher clinical success rates than stents used for PV lesions. Patients with a reasonable Life expectancy or who are unable to return for subsequent procedures should be considered for undergoing alternative therapy.