Inferior Vena Cava Reconstruction in Symptomatic Patients Using Palmaz Stents: A Retrospective Single-Center Experience

Abstract Purpose The use of stents for treating central venous occlusion is well described. Limited evidence exists related to Palmaz balloon-expandable stent use in inferior vena cava reconstruction. We analyzed patency and complication rates following inferior vena cava reconstruction using Palmaz stents. Materials and Methods From 2002 to 2019, 37 patients (mean age: 51 y) underwent inferior vena cava reconstruction with 68 Palmaz stents. Indications were symptomatic chronic venous obstruction in the infrarenal (n=25) and intrahepatic (n=12) IVC. Demographic, operative, and imaging data were evaluated. Clinical data, abdominal CT, and/or duplex ultrasound were used to determine patency at follow-up. Results Restoration of caval patency was achieved in all patients, with complications in 2/37 (5.4%) patients (thrombus formation within the stent; stent embolization eight days after placement). Follow-up data were available for 27 patients. Primary patency was maintained through last follow-up in 19/27 (70%) patients (mean: 1.1 y), with successful stent re-dilation performed in 6 patients. Mean duration of primary-assisted patency (n=5) was 1.2 y. Late lumen loss was (n=13) was 40% during a mean time to follow-up of 2.0 years. Primary patency in patients with occlusion secondary to malignancy was 109 d (range: 1 d-1.0 y), while primary patency in patients with occlusion from other etiologies was 1.1 y (range: 2 d – 5.9 y). Kaplan-Meier analysis demonstrated primary and primary-assisted patency of 66% and 84%, respectively, at 24 and 48-months. Conclusion Palmaz balloon-expandable stents for inferior vena cava reconstruction is feasible and effective for symptomatic inferior vena cava occlusion. Risk of stent migration was low.