Korean J Radiol.  2015 Aug;16(4):723-728. 10.3348/kjr.2015.16.4.723.

Stent Compression in Iliac Vein Compression Syndrome Associated with Acute Ilio-Femoral Deep Vein Thrombosis

• Cho H
• Kim JW
• Hong YS
• Lim SH
• Won JH

• KMID: 2155544
• DOI: http://doi.org/10.3348/kjr.2015.16.4.723

Abstract

OBJECTIVE
This study was conducted to evaluate stent compression in iliac vein compression syndrome (IVCS) and to identify its association with stent patency.
MATERIALS AND METHODS
Between May 2005 and June 2014, after stent placement for the treatment of IVCS with acute ilio-femoral deep vein thrombosis, follow-up CT venography was performed in 48 patients (35 women, 13 men; age range 23-87 years; median age 56 years). Using follow-up CT venography, the degree of the stent compression was calculated and used to divide patients into two groups. Possible factors associated with stent compression and patency were evaluated. The cumulative degree of stent compression and patency rate were analyzed.
RESULTS
All of the stents used were laser-cut nitinol stents. The proportion of limbs showing significant stent compression was 33%. Fifty-six percent of limbs in the significant stent compression group developed stent occlusion. On the other hand, only 9% of limbs in the insignificant stent compression group developed stent occlusion. Significant stent compression was inversely correlated with stent patency (p < 0.001). The median patency period evaluated with Kaplan-Meier analysis was 20.0 months for patients with significant stent compression. Other factors including gender, age, and type of stent were not correlated with stent patency. Significant stent compression occurred most frequently (87.5%) at the upper end of the stent (ilio-caval junction).
CONCLUSION
Significant compression of nitinol stents placed in IVCS highly affects stent patency. Therefore, in order to prevent stent compression in IVCS, nitinol stents with higher radial resistive force may be required.

Keyword

Iliac vein compression syndrome; Stent compression; Stent occlusion; Stent

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
Iliac Vein/pathology/*radiography
Kaplan-Meier Estimate
Male
May-Thurner Syndrome/*diagnosis/radiography/*therapy
Middle Aged
Phlebography
Retrospective Studies
Stents/adverse effects
Tomography, X-Ray Computed
Treatment Outcome
Vascular Patency/*physiology
Venous Thrombosis/radiography/*therapy
Young Adult

Figure

• 

  Fig. 1 Follow-up CT image shows significant stent compression and occlusion. On axial images, stent was compressed by crossing iliac artery at ilio-caval junction (A). On curved planar images, degree of stent compression was measured with caliper and calculated as diameter of stent at narrowest/widest point (bidirectional arrows) of stent × 100%. In this patient, stent was compressed more than 50% by crossing iliac artery at ilio-caval junction (B).

• 

  Fig. 2 Kaplan-Meier curves show patency rates according to stent compression rate. Median patency period was 20.0 months for patients with significant stent compression (p = 0.001).

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