Reconstruction of stenotic or occluded iliofemoral veins and inferior vena cava using intravascular stents: Re-establishing access for future cardiac catheterization and cardiac surgery

Frank Ing, Thomas E. Fagan, Ronald G. Grifka, Sandra Clapp, Michael R. Nihill, Mark Cocalis, James Perry, James Mathewson, Charles E. Mullins

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

OBJECTIVES: The study evaluated the safety and efficacy of stent reconstruction of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IVC). BACKGROUND. Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations. METHODS: Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic and 13 were completely occluded. Although guide wires were easily passed across the stenotic vessels, occluded vessels required puncture through the thrombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation. RESULTS: Following stent placement, the mean vessel diameter increased from 0.9 ± 1.6 to 7.4 ± 2.6 mm (p < 0.05). Twenty-one of 2.8 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repeat catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diameter of 6.4 ± 2.0 mm. Two vessels were occluded, but they were easily recanalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented vessel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessels (87%) remained patent at follow-up thus far. CONCLUSIONS: Stenotic/obstructed IFV and IVC may be reconstructed using stents to re-establish venous access to the heart for future cardiac catheterization and/or surgeries.

Original languageEnglish (US)
Pages (from-to)251-257
Number of pages7
JournalJournal of the American College of Cardiology
Volume37
Issue number1
DOIs
StatePublished - Jan 27 2001

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Inferior Vena Cava
Cardiac Catheterization
Thoracic Surgery
Stents
Veins
Congenital Heart Defects
Thigh
Punctures
Catheterization
Needles
Blood Vessels
Pathologic Constriction
Thrombosis
Biopsy
Safety

ASJC Scopus subject areas

  • Nursing(all)

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Reconstruction of stenotic or occluded iliofemoral veins and inferior vena cava using intravascular stents : Re-establishing access for future cardiac catheterization and cardiac surgery. / Ing, Frank; Fagan, Thomas E.; Grifka, Ronald G.; Clapp, Sandra; Nihill, Michael R.; Cocalis, Mark; Perry, James; Mathewson, James; Mullins, Charles E.

In: Journal of the American College of Cardiology, Vol. 37, No. 1, 27.01.2001, p. 251-257.

Research output: Contribution to journalArticle

Ing, Frank ; Fagan, Thomas E. ; Grifka, Ronald G. ; Clapp, Sandra ; Nihill, Michael R. ; Cocalis, Mark ; Perry, James ; Mathewson, James ; Mullins, Charles E. / Reconstruction of stenotic or occluded iliofemoral veins and inferior vena cava using intravascular stents : Re-establishing access for future cardiac catheterization and cardiac surgery. In: Journal of the American College of Cardiology. 2001 ; Vol. 37, No. 1. pp. 251-257.
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abstract = "OBJECTIVES: The study evaluated the safety and efficacy of stent reconstruction of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IVC). BACKGROUND. Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations. METHODS: Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic and 13 were completely occluded. Although guide wires were easily passed across the stenotic vessels, occluded vessels required puncture through the thrombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation. RESULTS: Following stent placement, the mean vessel diameter increased from 0.9 ± 1.6 to 7.4 ± 2.6 mm (p < 0.05). Twenty-one of 2.8 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repeat catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diameter of 6.4 ± 2.0 mm. Two vessels were occluded, but they were easily recanalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented vessel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessels (87{\%}) remained patent at follow-up thus far. CONCLUSIONS: Stenotic/obstructed IFV and IVC may be reconstructed using stents to re-establish venous access to the heart for future cardiac catheterization and/or surgeries.",
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AU - Ing, Frank

AU - Fagan, Thomas E.

AU - Grifka, Ronald G.

AU - Clapp, Sandra

AU - Nihill, Michael R.

AU - Cocalis, Mark

AU - Perry, James

AU - Mathewson, James

AU - Mullins, Charles E.

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AB - OBJECTIVES: The study evaluated the safety and efficacy of stent reconstruction of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IVC). BACKGROUND. Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations. METHODS: Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic and 13 were completely occluded. Although guide wires were easily passed across the stenotic vessels, occluded vessels required puncture through the thrombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation. RESULTS: Following stent placement, the mean vessel diameter increased from 0.9 ± 1.6 to 7.4 ± 2.6 mm (p < 0.05). Twenty-one of 2.8 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repeat catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diameter of 6.4 ± 2.0 mm. Two vessels were occluded, but they were easily recanalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented vessel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessels (87%) remained patent at follow-up thus far. CONCLUSIONS: Stenotic/obstructed IFV and IVC may be reconstructed using stents to re-establish venous access to the heart for future cardiac catheterization and/or surgeries.

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