We spoke to Prof. O’Sullivan to learn more about his presentation at CIRSE 2022.
Update on venous stents
So – what’s the big deal about venous stents anyway?
Veins are just like arteries – they carry blood; arteries from the heart; veins to the heart- they are just pipes – right?
Well, you may have noticed a fair bit of noise about venous stents over the past few years. Is this just industry-generated or is there something more to this?
Early in my career I started off purely “arterial” and have now ended up nearly entirely “venous”. My exposure to venous disease started with central venous access, then arterio-venous haemodialysis maintenance, then IVC filter insertion and retrieval. Along the way I started performing venous thrombectomy, then superior vena cava management; venous sampling, and latterly deep venous reconstruction and pelvic venous disease.
Venous stents are integral to almost the entire gamut of venous intervention.
Some of the principles you have learnt from arterial intervention certainly apply – good pre-operative imaging, proper planning, safe access; crossing the obstruction, and then appropriate use of balloons and stents. But the imaging is probably different; the site of access is almost certainly different; and the techniques for venous angioplasty and stenting also differ somewhat compared with those of arteries.
Stents have been used in veins since the beginning of the endovascular revolution. The BSCI Wallstent, which was designed in the early 1980s, is the longest established and worldwide probably still the most widely used stent, but since 2011 a whole range of new “venous-dedicated” stents have become available. They are constructed of different materials, have different features, are deployed differently, and come in different lengths and diameters.
The purpose of my lecture today is to acquaint you with some of these newer features, and to familiarise you with the ever-increasing number and variety of stents available. My co-lecturers and I may also provide a glimpse of what is around the corner. We will also discuss the recent venous stent withdrawals, why they occurred, and what we have learnt going forward.
Figures: Please click on the image to expand
Figure 1. Super tight May-Thurner lesion (a) AP and (b) lateral views. (c) Repeat PTA to 14 mm at 20 atm required.
University Hospital Galway, Galway/IE
Prof. Gerry O’Sullivan is a consultant interventional radiologist at the University Hospital Galway, Ireland. Previously, he held a consultant radiologist position at Rush University Medical Center in Chicago, USA. He specialises in vascular procedures and is particularly well known for his expertise in the venous field, especially DVT. Besides his work on deep venous disease therapies, he is also collaborating on several novel medical device developments. Prof. O’Sullivan has served as CIRSE Membership Committee Chairperson and has just been voted SPC Deputy-Chairperson. His tenure will begin after CIRSE 2022. Follow him on Twitter @lahinchman!
- Dabir D, Feisst A, Thomas D, Luetkens JA, Meyer C, Kardulovic A, Menne M, Steinseifer U, Schild HH, Kuetting DLR. Physical Properties of Venous Stents: An Experimental Comparison. Cardiovasc Intervent Radiol. 2018 Jun;41(6):942-950. doi: 10.1007/s00270-018-1916-1. Epub 2018 Feb 28. PMID: 29492633.
- O’Sullivan GJ, Sheehan J, Lohan D, McCann-Brown JA. Iliofemoral venous stenting extending into the femoral region: initial clinical experience with the purpose-designed Zilver Vena stent. J Cardiovasc Surg (Torino). 2013 Apr;54(2):255-61. PMID: 23558660.
- Mahnken AH, Thomson K, de Haan M, O’Sullivan GJ. CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Intervent Radiol. 2014 Aug;37(4):889-97. doi: 10.1007/s00270-014-0875-4. Epub 2014 Mar 15. PMID: 24633533.
- Bajwa R, Bergin D, O’Sullivan GJ. Aiming for the Bottom Corner: How to Score a Field Goal When Landing Venous Stents in May-Thurner Syndrome. J Vasc Interv Radiol. 2019 Oct;30(10):1555-1561. doi: 10.1016/j.jvir.2019.04.033. Epub 2019 Aug 27. PMID: 31471189.
- O’Sullivan GJ. The role of interventional radiology in the management of deep venous thrombosis: advanced therapy. Cardiovasc Intervent Radiol. 2011 Jun;34(3):445-61. doi: 10.1007/s00270-010-9977-9. Epub 2010 Oct 7. PMID: 20927522.
- Kurstjens, R; De Wolf, M; Konijn, H; Toonder, I. M.; Nelemans, P; Laanen, J; de Graaf, R; Wittens, C. The Effect of Stenting on Venous Hypertension: Results Using a Treadmill Stress Test with Invasive Pressure Measurements in Patients with Iliofemoral Venous Obstruction. DO – 10.1016/j.ejvs.2018.04.013. European Journal of Vascular and Endovascular Surgery
- Sayed, M.H., Salem, M., Desai, K.R., O’Sullivan, G.J., Black, S.A. A review of the incidence, outcome, and management of venous stent migration. Journal of Vascular Surgery: Venous and Lymphatic Disorders, Volume 10, Issue 2, March 2022. https://doi.org/10.1016/j.jvsv.2021.07.015