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Semin Thromb Hemost 2024; 50(06): 883-893
DOI: 10.1055/s-0044-1786755
Review Article

Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis

Javier Trujillo-Santos
1   Internal Medicine Department, Venous Thromboembolism Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
2   Universidad Católica San Antonio, Región de Murcia, Spain
3   Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
,
Pablo Demelo-Rodríguez
3   Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
4   Department of Internal Medicine, Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Sanitary Research Institute Gregorio Marañón, Madrid, Spain
,
Alexis Bravo de Laguna-Taboada
5   Interventional Radiology Service, Hospital Insular de Gran Canaria, Las Palmas, Spain
6   Sociedad Española de Radiología Vascular e Intervencionista
,
Santiago Zubicoa-Ezpeleta
6   Sociedad Española de Radiología Vascular e Intervencionista
7   Unidad de Radiología Intervencionista, Hospital Ruber Internacional, Madrid
,
Alejandro Rodríguez-Morata
8   Servicio de Angiología y Cirugía Vascular, Hospital Quirónsalud Málaga, Málaga, Spain
9   Sociedad Española de Angiología y Cirugía Vascular, Madrid, Spain
,
Ignacio Lojo-Rocamonde
9   Sociedad Española de Angiología y Cirugía Vascular, Madrid, Spain
10   Servicio de Angiología y Cirugía Vascular, Hospital Quirónsalud A Coruña, A Coruña, Spain
,
Antoni Riera-Mestre
3   Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
11   Internal Medicine Department, Venous Thromboembolism Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona, Spain)
12   Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat (Barcelona), Spain
13   Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
,
on behalf of the Working Group on for the Consensus on Venous Stenting › Institutsangaben Funding This study project was funded by an unrestricted grant from Becton Dickinson.
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Abstract

Introduction Deep vein thrombosis (DVT) poses a complex challenge and often leads to postthrombotic syndrome (PTS), a debilitating complication. The emergence of venous stents offers a potential preventive avenue against this complication. This study aimed to provide consensus recommendations on the use of venous stent for DVT.

Materials and Methods From June to July 2023, 20 internal medicine, angiology and vascular surgery, and vascular and interventional radiology experts were involved in the Delphi process. Thirty-one recommendations, categorized into three thematic areas, were rigorously evaluated: indications for stent use, stent selection and placement, and monitoring and prevention of complications. Agreement was evaluated using a Likert scale, with consensus defined as agreement by two-thirds of the participants.

Results Consensus was reached for 23 (74.2%) of 31 recommendations. The agreement was centered on considerations, such as stent placement in specific acute DVT scenarios, emphasizing pivotal stent characteristics. However, there were divergences in the recommended stent length to prevent migration and stent characteristics based on iliocaval bifurcation morphology. Notably, there was no consensus on whether patients with DVT caused by a major transient risk factor need more than 3 months of anticoagulation therapy or whether aspirin should be added to anticoagulant treatment after venous stenting.

Conclusions These consensus recommendations offer practical insights into optimizing venous stent use to prevent PTS in DVT patients. Addressing the critical aspects of stent selection, placement, and postprocedural care, these recommendations contribute to clinical decision-making. The identified divergences underscore the importance of consensus and thus indicate the need for further investigation.

Keywords

deep vein thrombosis - postthrombotic syndrome - endovascular interventions - venous stent - stenting - consensus

Working Group for the Consensus on Venous Stenting (in Alphabetical Order)

Borja Castejón Navarro (Complejo hospitalario Ruber Juan Bravo, Madrid, Spain); Eduardo Crespo Vallejo (Fundación Jiménez Díaz, Madrid, Spain); Eva Criado Paredes (Corporació Sanitària Parc Taulí, Barcelona, Spain); Juan Fontcuberta García (Hospital de La Zarzuela, Hospital de la Moraleja, Madrid, Spain); Francisco Galeano Valle (Hospital Universitario Gregorio Marañón, Madrid, Spain); Íñigo Insausti Gorbea (Clínica Universitaria de Navarra, Pamplona, Spain); Luis Izquierdo Lamoca (Hospital Universitario HM Puerta del Sur, Madrid, Spain); Juan José López Núñez (Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain); Alicia Lorenzo Hernández (Hospital Universitario La Paz, Madrid, Spain); Ana Maestre Peiró (Hospital Universitario de Vinalopó, Elche Alicante); Oscar Merino Mairal (Clínica Rotger Quironsalud, Palma, Spain); Manuel Jesús Núñez Fernández (Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; Sonia del Pilar Otalora Valderrama (Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain); Maria Luisa Robles Martín (Hospital Quirónsalud, Málaga, Spain); Ruben Rodríguez Carvajal (Hospital Quirónsalud Campo de Gibraltar, Cádiz, Spain).


Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
11. Mai 2024

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