Stent migration following treatment of acute iliofemoral thrombus or venous obstruction is “rare but may be underreported,” with the majority of reported cases being shorter and smaller diameter stents. This is the main concluding finding of a systematic review published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.
First-named author Mohamed Hosny Sayed, MRCS, of the vascular surgery department at Guys & St Thomas’ NHS Foundation Trust, St Thomas’ Hospital in London, England, and colleagues note that little research is available on percutaneous endovenous stenting—the primary treatment for acute iliofemoral thrombus or venous obstruction. In order to address this paucity in the literature, Sayed et al carried out a systematic review, with the specific aims of identifying the number of cases reported in published literature, as well as recognizing associated risk factors and outcomes of venous stenting.
Following data collection, the researchers included cases between 1994 and 2020 in their review. Sayed and colleagues reveal that a total of 31 articles, consisting of 29 case reports and two case series, provided data for 54 reported events of venous stent migration. Of these 54 cases, only 47 provided details on the size of stent used. The average age of the patients in whom stent migration was reported was 50 years (range 19–88), and 57.6% (n=30) of the cohort were male. The authors also relay that, in 85% of the migrated stent events, retrieval was attempted with 56% via an endovascular approach. In these cases, immediate outcome was reported to be 100%, regardless of retrieval approach, however, Sayed et al point out that stent migration could result in immediate death, which precluded attempts at retrieval.
The review found that no migrated stents were reported to be larger than 100mm in length, with 38 out of 46 (82.6%) reported to be less than 60mm, and only 3.6% of reported migrations involved stents greater than 14mm in diameter.
Sayed and colleagues conclude that venous stent migration appears to be a rare complication of venous stenting, however, when it does occur, has the potential to cause “significant morbidity and mortality.” The data also suggest that migration is more likely to occur with shorter length (≤60mm) and smaller diameter (≤14mm) stents, with the combination being the most common. “This adds weight to the significant role that appropriate sizing of stents in treatment may play in preventing this catastrophic complication,” senior author Stephen Black, MD, of the department of vascular surgery at St Thomas’ Hospital, King’s College London, London, remarks, speaking to Vascular Specialist partner publication, Venous News.
Looking ahead, Sayed and colleagues write that “more formal data collection would provide a truer reflection of incidence,” especially given that this complication is “undoubtedly underreported,” according to Black. They highlight that the data retrieved for this review were of too low quality for meaningful statistical analysis. However, the researchers also stress that “clear strategies to avoid migration need to be followed to prevent this complication occurring.” This is “strongly related” to training and education, says Black, which he believes “may help prevent patients coming to harm.”