Let's Talk About Stents

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby mrhodes40 » Tue Dec 01, 2009 6:18 pm

Here's an abstract on stents in the vena cava the vein right next to the heart They used large stents flared at both ends for this. These patients were very ill ....
Long-term results of treatment of benign central venous obstructions unrelated to dialysis with expandable Z stents.
PMID 10392944
Abstract PURPOSE: To evaluate long-term patency of self-expanding Z stents for treatment of benign central venous obstructions unrelated to dialysis. MATERIALS AND METHODS: Z stents were placed in 19 patients, (ages 26-72 years) with severe symptomatic obstructions of the superior or inferior venae cavae and their large branches and portal vein caused by surgical or catheter injury (n = 8), fibrosis (n = 5), cirrhosis (n = 3), Budd-Chiari syndrome (n = 2), and extrinsic compression (n = 1). Fourteen patients underwent stent placement primarily, five after local urokinase infusion for superimposed thrombosis. Follow-up was performed with ultrasound and venography. RESULTS: Venous congestive symptoms quickly resolved in all patients after stent placement. The follow-up period was from 1 to 94 months. Twelve patients have died during follow-up from 1 to 37 months although all remained asymptomatic until death. Six patients remain alive, asymptomatic, with patent stents, and with follow-up from 24 to 94 months. Primary patency was 83%, and secondary patency was 100%. One patient with a patent stent at 12 months was lost to follow-up. No stent migrations, perforations, infections, or significant complications occurred. CONCLUSION: Benign central venous obstructions are effectively treated by the placement of self-expandable Z stents. Placed percutaneously into obstructive lesions with a minimum risk, these stents offer long-term durability and patency.

Here's another. This one is interesting because these ladies had something outside the vein pushing on it so the stent was to keep it open in the face of this pressure (a lot like my stents in the high jugs)
PMID 7705669
Abstract Patients with gynecologic malignancies may develop stenosis of the large pelvic veins as a result of their disease or its treatment. The percutaneous insertion of a stainless steel vascular stent is a novel approach to the management of an extrinsically compressed vein. The objective of this study was to review the results of treating lower extremity edema secondary to a pelvic venous stenosis through the percutaneous insertion of a stainless steel vascular stent. A retrospective review was performed on gynecologic oncology patients who presented with an edematous lower extremity and underwent an evaluation to diagnose proximal venous stenosis. The evaluation included sonography, venography, and balloon angioplasty prior to the percutaneous insertion of a stainless steel vascular stent. If a venous thrombosis was documented, thrombolysis with urokinase was performed prior to evaluation for venous stenosis. Records were reviewed for the etiology of the venous stenosis, the location and type of stent inserted, and the ability of the stent to maintain patency and provide symptomatic relief. Patency was evaluated at 1-week and then at 1-, 3-, and 6-month intervals. The probability of vascular stent patency was calculated using life table analysis. Ten patients with cervical (n = 4), corpus (n = 3), ovarian (n = 1), vulvar (n = 1), and vaginal (n = 1) cancer had one or more vascular stents inserted for the treatment of a stenosed pelvic vein. The etiologies of venous stenosis were radiation fibrosis and surgery (n = 5), postoperative fibrosis (n = 3), and metastatic tumor (n = 2). The stented vessels were the left common (n = 5) or left external (n = 4) iliac veins, the right common (n = 1) or right external (n = 3) iliac veins, and the right common femoral vein (n = 1). The median follow-up was 21 months. All patients had subjective resolution of their edematous extremity while the stents were patent. The interval probability of patency of stented veins was greater than 85% at each evaluation interval. Patency was 100% for patients beyond 6 months of follow-up. There were no major complications. The percutaneous intravascular insertion of a stainless steel stent was safe and subjectively effective in the management of venous stenosis associated with a gynecologic cancer. A prospective trial with objective endpoints may be warranted.
Authors L F Carson , L B Twiggs , L L Adcock , D W Hunter , J M Fowler , K E Dusenbery , J R Carter , E Hartenbach , G K Nazarian , J W Carlson
Journal Title Gynecologic oncology

this next one is central veins, mediastinal is the chest

[Stent or bypass? Treatment results in benign central venous obstruction]
PMID 11446065
Abstract PURPOSE: Surgical treatment of central venous obstruction is difficult and sometimes hazardous, but not always successful. Sufficient palliation of malign stenoses can often be achieved by stent implantation. Thus it seems necessary to define the relative value of stenting in comparison to surgical reconstruction for the treatment of benign obstructions, with special respect to the long-term results. METHODS: Between 1990 and 1999, 64 central venous stents were implanted. Mediastinal vein obstructions in 23 hemodialysis patients were treated with a total of 35 stents. 29 iliofemoral stents were implanted following operative or conservative treatment of 21 venous thromboses. During the same time period, only 6 surgical bypasses were performed (all in hemodialysis patients). All patients were followed-up prospectively. Patency rates were calculated according to the life table-method. RESULTS: Following stent implantation one asymptomatic pulmonary stent embolism (2.3%) ---they mean a stent that went to the lungs mr---and three stent misplacements (6.8%) were documented. Two of the latter were successfully treated with another stent. In the surgical group, one patient died at eight weeks due to late complications of a cephalosporine-associated Lyell syndrome. One to five year patency rates were not significantly different among the three groups. CONCLUSION: For benign central venous stenoses in hemodialysis patients and following iliofemoral venous thrombosis, stent implantation can be recommended as a simple, safe, and durable means to restore patency. Still there is a role for surgery in severely symptomatic central venous occlusions when stent implantation is impossible or has failed. [b]

Subclavian veins drain into the innominate as does the jugular THis situastion is a little different in that the veins were damaged to begin with by a implanted medical device.

Access-related venous stenoses and occlusions: treatment with percutaneous transluminal angioplasty and Dacron-covered stents.
PMID 10382052
Abstract PURPOSE: To determine the effectiveness of using Dacron-covered stents to treat access-related venous stenoses and occlusions. METHODS: Twenty-two Dacron-covered stents were placed in [b]20 patients: in the basilic or axillary vein (n = 2), cephalic vein (n = 3), subclavian vein (n = 5), and at the venous anastomosis of the polytetrafluoroethylene (PTFE) implant graft (n = 10). RESULTS: Initial technical success was 100%. The cumulative primary and secondary patency rates were 57% and 83% at 6 months, 29% and 64% at 12 months, and 29% and 53% at 18 months. A statistically significant difference in the stent patency was revealed by comparing the patients with stents in the subclavian vein and patients with upper arm stents. The secondary patency rates of the upper arm stents were 73% after 6, 12, and 18 months. CONCLUSIONS: Percutaneous placement of Dacron-covered stents is a safe and effective procedure for salvage of a dialysis fistula. First results are promising, with a tendency to prolongation of the time interval between reinterventions.
Authors E Gmelin , J H Grunert , M M Barbey , A Farber
Journal Title Cardiovascular and interventional radiology

I actually saw a study on 12 people treated with transverse sinus stents--that is the next vein UP from the jugs. They were thrombosed so it was lifesaving rather than "elective". I'll go look for it if someone wants it badly :wink:

These are a few papers of the search list I had, I THOUGHT I had seen a paper on stent retrieval from the heart endovascularly but apparently not, I can't find it! but I found these so decided to put them on here.

I did see the paper on the person who had a stent placed in a iliofemoral location and deep massage had fractured it and sent it to the heart.

All have pubmed ID # so the absract can be gotten from pubmed with that number (I wasn't on pubmed)
I'm not offering medical advice, I am just a patient too! Talk to your doctor about what is best for you...
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Postby MS_mama » Tue Dec 01, 2009 8:03 pm

There's two issues here:
* how much research and investigation is needed before a procedure like this becomes "approved" (FDA, etc) and widespread

* how much research is needed before an individual decides to go ahead and have the procedure done.

For some of us, the bar is higher for FDA type approval vs. our own situation. I wouldn't mind going ahead and having an angio procedure done, for example, before more detailed studies come out. I don't want to wait excessively long while I watch my symptoms accumulate. Others would rather wait until the studies reach a level of FDA type approval. Like Jamie said, there's no right answer.

And on the FDA approval issue, history is replete with examples of things rushed through without good enough studies/research. Vioxx, Tysabri (the first time around), drugs that have post-hoc "black box warnings" that get appended AFTER people die, phased out vaccines like DTP, the old rotavirus vax, etc. There are tons of stuff out there even now that are "approved" but I think need a closer look but that's another can of worms :)

Unless CCSVI gets a big pharma sponsor like Cordis stents or something that will push through the studies in good old fashioned big pharma style, it's gonna be a long hard haul to get anything approved as a first-line treatment.
dx RRMS Jun. 2009...on Copaxone and LDN and waiting for my turn to be "liberated"<br />
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