Stenting of stenotic or occluded iliofemoral veins, superior and inferior vena cavae in children with congenital heart disease: Acute results and intermediate follow up

Objectives: To determine the short and intermediate term outcome following systemic venous stent placement in children with congenital heart disease. Background: Patients with congenital heart disease are at risk of stenosis or occlusion of systemic veins following indwelling lines or catheterizations. Stent dilation may ameliorate symptoms and open the vessel for use during future procedures. We report our acute and intermediate results. Methods: All patients with systemic venous stent placement in the iliofemoral veins, inferior or superior vena cava at our institution between 1998 and 2006 were included. Initial and the follow-up catheterization data were reviewed retrospectively. Results: 70 stents were placed in 33 patients (36 vessels). Median age was 2.6 years (0.2-14.2)and weight 11.5 kg (3.8-78.7). 17/36 vessels (47%) were occluded requiring recanalization. Following stent delivery, the mean minimum vessel diameter increased from 3.1 ± 3.2 to 7.2 ± 3.0 mm (P < 0.001). There were no major complications. Seventeen patients and vessels had a total of 62 follow-up catheterizations, with median length of follow-up 4.1 years (0.7-9.3). During intermediate follow up, 7/17 vessels (41%) required additional intervention. Six patients had additional balloon dilation of existing stents, and one additional stent was placed. Vessels were further dilated to 8.4 ± 3.5 mm at the last catheterization. Conclusion: Systemic venous stents are safe and effective in recanalizing stenosed or occluded vessels. At follow-up, reocclusion can occur, however, previously placed stents can be safely recanalized if necessary. Future studies will determine if stenting is indicated in a broader population.