Chronic obstruction of the common femoral vein in patients with the post-thrombotic syndrome (PTS) after iliofemoral or iliocaval deep vein thrombosis remains a challenge for endovascular treatment. Patency rates and clinical outcomes of laser-cut and braided nitinol stents extending to the common femoral vein have not been studied yet.
PATIENTS AND METHODS
From the Swiss and Arnsberg Venous Stent registries, we included 150 PTS patients (mean age 44±16 years, 48% women) with laser-cut (n=101) and braided nitinol (n=49) stents placed into the common femoral vein across the inguinal ligament. Routine follow-up included duplex ultrasound examinations and assessment of clinical scores. The primary study outcome was primary and secondary patency at 12 months.
Overall, mean number of implanted stents was 2.6±1.7. The proximal stent landing zone was the inferior vena cava in 32 (21%) patients, the iliac vein in 106 (76%), and the common femoral vein in 5 (3%). Primary patency rate was 67.3% (95%CI 58.0-76.6%) in the laser-cut and 86.7% (95%CI 75.3-98.1%) in the braided stent group (logrank p=0.016). Secondary patency rate was 93.9% (95%CI 89.2-98.6) and 100% respectively (logrank p=0.10). The median improvement in Villalta score from baseline to the latest follow-up was 4 (IQR: 2-6) points, without difference between the groups. Symptomatic common femoral vein stent fractures were observed in four (4%) patients with laser-cut stents and in no patient with braided stent.
Braided as compared with laser-cut nitinol stents for common femoral vein obstruction appeared to be associated with favorable primary patency rates at 12 months. Further studies are needed to confirm that braided nitinol stents remain patent and may be less prone to fractures in the long term.