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DOI: 10.1055/s-0044-1786755
Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis
Funding This study project was funded by an unrestricted grant from Becton Dickinson.
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 - consensusWorking 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).
Publication History
Article published online:
11 May 2024
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