Reasons for Stent Failure in the Iliocaval Veins

Adult patient data for stents placed from the IVC to the CFV was collected in four university hospitals. Diagnosis of stent failure was documented by objective imaging. Data was collected on patient demographics, obstruction type, symptoms, stent type, time from stent implantation, diameter stenosis, and reason for stent failure. The main categories for stent failure were technical, patient management, both having multiple reasons for stent failure, and patient compliance. All the reasons for stent failure were collected in individual patients.

Results:

The patient group (currently n=112) was predominantly female (63.4%) with an average age of 43.9±14.7 years. Most stents were placed for a post thrombotic obstruction (92%) and the rest (8%) for a non-thrombotic obstruction. Stent failure from the time of implantation varied from the day of the procedure to 10 years. Most of the failures occurred within 1 year. Thrombophilia was present in 20 patients in 2 centers, and it was not known if it was the reason for failure. 65 patients had 1 reason for stent failure, 20 patients had more than 1 reason and 27 patients were unknown. Across the 4 centers, 20 possible reasons were identified for stent failure that were grouped into 5 categories: residual disease (42.0%), technical (26.8%), coagulation-related (19.6%), other (7.1%), and unknown (24.1%). More specifically, the top known reasons for stent failure included inflow disease (31.3%), anticoagulation therapy (AC) (16.1%), and outflow disease (10.7%).

Conclusion:

A preliminary profile for stent failure was built in this ongoing study. Although various reasons are responsible for stent failure, more attention should be directed toward correcting residual disease, avoiding errors in technique, and improving anticoagulation management. Creation of robust registries will help to gather detailed information and further improve clinical outcomes.