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 (AVF) and no prior catheter (2%), and other (10%). All PV lesions resulted from complications of dialysis. Indications for CV stents included limb edema (46%), AVF malfunction (30%), both limb edema and AVF malfunction (14%), and other (10%). PV stent indications were AVF 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 AVF. 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.