Download PDF
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 › Author Affiliations Funding This study project was funded by an unrestricted grant from Becton Dickinson.
› Further Information
   Permissions and Reprints

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



Publication History

Article published online:
11 May 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol 2007; 44 (02) 62-69
    CrossrefPubMedSearch in Google Scholar
  • 2 Huang J, Liu XY, Wu ZP, Ma YK. Quality of life status and influencing factors among patients with deep vein thrombosis. Patient Prefer Adherence 2022; 16: 949-956
    CrossrefPubMedSearch in Google Scholar
  • 3 Galanaud JP, Holcroft CA, Rodger MA. et al. Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency. J Thromb Haemost 2013; 11 (03) 474-480
    CrossrefPubMedSearch in Google Scholar
  • 4 Kahn SR, Shrier I, Julian JA. et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008; 149 (10) 698-707
    CrossrefPubMedSearch in Google Scholar
  • 5 Kahn SR, Comerota AJ, Cushman M. et al; American Heart Association Council on Peripheral Vascular Disease, Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation 2014; 130 (18) 1636-1661
    CrossrefPubMedSearch in Google Scholar
  • 6 Hansson PO, Sörbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med 2000; 160 (06) 769-774
    CrossrefPubMedSearch in Google Scholar
  • 7 Schellong SM, Goldhaber SZ, Weitz JI. et al. Isolated distal deep vein thrombosis: perspectives from the GARFIELD-VTE registry. Thromb Haemost 2019; 119 (10) 1675-1685
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Ortel TL, Neumann I, Ageno W. et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4 (19) 4693-4738
    CrossrefPubMedSearch in Google Scholar
  • 9 Tran HA, Gibbs H, Merriman E. et al. New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism. Med J Aust 2019; 210 (05) 227-235
    CrossrefPubMedSearch in Google Scholar
  • 10 Kearon C, Akl EA, Comerota AJ. et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 2012; 141 (2, Suppl): e419S-e496S
    CrossrefPubMedSearch in Google Scholar
  • 11 Makedonov I, Kahn SR, Galanaud JP. Prevention and management of the post-thrombotic syndrome. J Clin Med 2020; 9 (04) 923
    CrossrefPubMedSearch in Google Scholar
  • 12 Black SA, Alvi A, Baker SJ. et al. Management of acute and chronic iliofemoral venous outflow obstruction: a multidisciplinary team consensus. Int Angiol 2020; 39 (01) 3-16
    CrossrefPubMedSearch in Google Scholar
  • 13 Breen K. Role of venous stenting for venous thromboembolism. Hematology (Am Soc Hematol Educ Program) 2020; 2020 (01) 606-611
    CrossrefPubMedSearch in Google Scholar
  • 14 Vedantham S, Weinberg I, Desai KR. et al. Society of interventional radiology position statement on the management of chronic iliofemoral venous obstruction with endovascular placement of metallic stents. J Vasc Interv Radiol 2023; 34 (10) 1643-1657.e6
    CrossrefPubMedSearch in Google Scholar
  • 15 Rossi FH, Kambara AM, Izukawa NM. et al. Randomized double-blinded study comparing medical treatment versus iliac vein stenting in chronic venous disease. J Vasc Surg Venous Lymphat Disord 2018; 6 (02) 183-191
    CrossrefPubMedSearch in Google Scholar
  • 16 van Vuuren TM, van Laanen JHH, de Geus M, Nelemans PJ, de Graaf R, Wittens CHA. A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol. BMJ Open 2017; 7 (09) e017233
    CrossrefPubMedSearch in Google Scholar
  • 17 Meng QY, Li XQ, Jiang K. et al. Stenting of iliac vein obstruction following catheter-directed thrombolysis in lower extremity deep vein thrombosis. Chin Med J (Engl) 2013; 126 (18) 3519-3522
    CrossrefPubMedSearch in Google Scholar
  • 18 Taha MA, Busuttil A, Bootun R, Davies AH. A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb. Phlebology 2019; 34 (02) 115-127
    CrossrefPubMedSearch in Google Scholar
  • 19 Williams ZF, Dillavou ED. A systematic review of venous stents for iliac and venacaval occlusive disease. J Vasc Surg Venous Lymphat Disord 2020; 8 (01) 145-153
    CrossrefPubMedSearch in Google Scholar
  • 20 Ferreira AM, Oliveira-Pinto J, Duarte-Gamas L, Coelho A, Mansilha A. Mid-term patency of iliac venous stenting for post-thrombotic syndrome. Int Angiol 2021; 40 (03) 196-205
    CrossrefPubMedSearch in Google Scholar
  • 21 Badesha AS, Bains PRS, Bains BRS, Khan T. A systematic review and meta-analysis of the treatment of obstructive chronic deep venous disease using dedicated venous stents. J Vasc Surg Venous Lymphat Disord 2022; 10 (01) 267-282.e4
    CrossrefPubMedSearch in Google Scholar
  • 22 Sayed MH, Salem M, Desai KR, O'Sullivan GJ, Black SA. A review of the incidence, outcome, and management of venous stent migration. J Vasc Surg Venous Lymphat Disord 2022; 10 (02) 482-490
    CrossrefPubMedSearch in Google Scholar
  • 23 Badesha AS, Siddiqui MM, Bains BRS, Bains PRS, Khan T. A systematic review on the incidence of stent migration in the treatment of acute and chronic iliofemoral disease using dedicated venous stents. Ann Vasc Surg 2022; 83: 328-348
    CrossrefPubMedSearch in Google Scholar
  • 24 Duarte-Gamas L, Rocha-Neves JP, Pereira-Neves A, Dias-Neto M, Baekgaard N. Contralateral deep vein thrombosis after stenting across the iliocaval confluence in chronic venous disease - a systematic review. Phlebology 2020; 35 (04) 221-230
    CrossrefPubMedSearch in Google Scholar
  • 25 Notten P, van Laanen JHH, Eijgenraam P. et al. Quality of anticoagulant therapy and the incidence of in-stent thrombosis after venous stenting. Res Pract Thromb Haemost 2020; 4 (04) 594-603
    CrossrefPubMedSearch in Google Scholar
  • 26 Jones J, Hunter D. Consensus methods for medical and health services research. BMJ 1995; 311 (7001) 376-380
    CrossrefPubMedSearch in Google Scholar
  • 27 Diamond IR, Grant RC, Feldman BM. et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 2014; 67 (04) 401-409
    CrossrefPubMedSearch in Google Scholar
  • 28 Vedantham S, Desai KR, Weinberg I. et al. Society of interventional radiology position statement on the endovascular management of acute iliofemoral deep vein thrombosis. J Vasc Interv Radiol 2023; 34 (02) 284-299.e7
    CrossrefPubMedSearch in Google Scholar
  • 29 Mazzolai L, Aboyans V, Ageno W. et al. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J 2018; 39 (47) 4208-4218
    CrossrefPubMedSearch in Google Scholar
  • 30 Kakkos SK, Gohel M, Baekgaard N. et al; Esvs Guidelines Committee. Editor's choice - European society for vascular surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg 2021; 61 (01) 9-82
    CrossrefPubMedSearch in Google Scholar
  • 31 Taha MAH, Busuttil A, Bootun R. et al. A clinical guide to deep venous stenting for chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord 2022; 10 (01) 258-266.e1
    CrossrefPubMedSearch in Google Scholar
  • 32 Lim CS, Black SA. Mechanical characteristics of venous stents to overcome challenges of venous outflow obstruction. Int Angiol 2022; 41 (03) 240-248
    PubMedSearch in Google Scholar
  • 33 Machado H, Sousa J, Mansilha A. The impact of venous stenting across the inguinal ligament on primary patency: a systematic review. Int Angiol 2021; 40 (04) 270-276
    CrossrefPubMedSearch in Google Scholar
  • 34 Neglén P, Darcey R, Olivier J, Raju S. Bilateral stenting at the iliocaval confluence. J Vasc Surg 2010; 51 (06) 1457-1466
    CrossrefPubMedSearch in Google Scholar
  • 35 Le TB, Lee TK, Park KM, Jeon YS, Hong KC, Cho SG. Contralateral deep vein thrombosis after iliac vein stent placement in patients with May-Thurner syndrome. J Vasc Interv Radiol 2018; 29 (06) 774-780
    CrossrefPubMedSearch in Google Scholar
  • 36 Dumantepe M, Aydin S, Ökten M, Karabulut H. Endophlebectomy of the common femoral vein and endovascular iliac vein recanalization for chronic iliofemoral venous occlusion. J Vasc Surg Venous Lymphat Disord 2020; 8 (04) 572-582
    CrossrefPubMedSearch in Google Scholar
  • 37 De Maeseneer MG, Kakkos SK, Aherne T. et al; Esvs Guidelines Committee. Editor's choice - European society for vascular surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg 2022; 63 (02) 184-267
    CrossrefPubMedSearch in Google Scholar
  • 38 Notten P, Ten Cate H, Ten Cate-Hoek AJ. Postinterventional antithrombotic management after venous stenting of the iliofemoral tract in acute and chronic thrombosis: a systematic review. J Thromb Haemost 2021; 19 (03) 753-796
    CrossrefPubMedSearch in Google Scholar
  • 39 Milinis K, Thapar A, Shalhoub J, Davies AH. Antithrombotic therapy following venous stenting: international delphi consensus. Eur J Vasc Endovasc Surg 2018; 55 (04) 537-544
    CrossrefPubMedSearch in Google Scholar
  • 40 Xiao N, Genet M, Khaja M, Desai KR. Antithrombotic therapy after deep venous intervention. Semin Intervent Radiol 2022; 39 (04) 357-363
    Thieme ConnectPubMedSearch in Google Scholar