Use of Novel Dedicated Venous Stents Associated with Less Extension into the Inferior Vena Cava without Reduced Early Patency Rates

Novel dedicated nitinol venous stents are optimally designed for deployment and treatment of iliofemoral venous disease. Previous studies have confirmed their efficacy and safety in iliac vein stenting however, comparative outcomes against nondedicated self-expanding stents have not been studied. The objective of this study was to compare technical and clinical outcomes of novel dedicated to nondedicated venous self-expanding stents. Patients who underwent stenting for clinically diagnosed thrombotic or nonthrombotic iliofemoral vein lesions (NIVL) between 2014 and 2021 at a single institution were identified and divided into two groups based on use of a novel dedicated nitinol stent. A retrospective review of demographic, operative, and follow-up data was performed. Primary outcomes were 30-day and 1-year patency. A χ2 analysis, logistic regression, and Kaplan-Meier survival analysis were used to determine outcomes. We identified 135 patients (186 limbs, 51 bilateral) who underwent iliofemoral venous stenting (mean age, 48.6 ± 16 years; 94 female; 16.7% NIVL). Use of a novel dedicated stent (Venovo [BD Biosciences, Franklin Lake, NJ], Vici [Boston Scientific, Marlborough, Mass], or Zilver Vena [Cook Medical, Bloomington, Ind]) was reported in 63 limbs (33.9%). Of the remaining 123 limbs, Wallstent (Boston Scientific) was deployed in 102 (82.9%) cases. Extension into the inferior vena cava (18.2% vs 82.1%; P < .001) and total number of stents used per limb (1.4 vs 2.1; P < .001) were significantly reduced with novel dedicated stent deployment at the iliocaval confluence. Mean diameter stent size was lower among novel dedicated stents compared to Wallstents alone (14.5 ± 2.4 vs 15.9 ± 2.1 cm; P = .047). There was no significant difference in 30-day (96.8% vs 93.5%; P = .34) or 1-year patency (89.9% vs 84.8%; P = .536) between use of novel dedicated and nondedicated venous stents. On subgroup multivariate regression analysis, novel dedicated stent use was not found to protect against stent reintervention in either thrombotic disease or NIVL. Infrainguinal stent fracture without thrombosis occurred in 1 patient (1.6%) from the novel dedicated stent group. No cases of stent migration were observed in either group. Mean follow-up was 8.1 ± 12.3 months for novel dedicated stents and 17.8 ± 18.2 months for nondedicated stents (Figure). The use of novel dedicated venous stents is associated with less stent extension into the inferior vena cava and fewer stents being deployed per limb at the iliocaval confluence. Despite this, there were no differences in early patency rates when compared to nondedicated stents. Longer term follow-up is needed to validate clinical outcomes.