A systematic review and meta-analysis of over 1,500 venous stenting procedures—said to be the first study on this topic to date—has highlighted an 18% drop in primary patency rates after one-year follow-up with declining rates beyond 12 months. As a result, researchers highlight the need for surveillance and consideration of reintervention to optimise long-term outcomes.
The study, published as an editor’s choice paper in the European Journal of Vascular and Endovascular Surgery (EJVES), aimed to appraise recent evidence assessing patency outcomes at various time points in patients with superior vena cava, subclavian, and brachiocephalic vein stenosis who had undergone stenting.
As a starting point, Shreya Chawla (Imperial College London, London, UK), Qingwei Zhang (St George’s University Hospital, London, UK), Adam Gwozdz (Imperial College London, London, UK) and colleagues, under the senior authorship of Stephen Black (St Thomas’ Hospital, London, UK), searched PubMed, Scopus, and Cochrane Library databases for studies up to December 2022. The researchers then measured outcomes including technical success rate, and primary, primary-assisted, and secondary patency rates at various time points.
Chawla, Zhang, Gwozdz et al share that they included a total of 39 studies reporting outcomes in 1,539 patients in their meta-analysis.
The authors report that primary patency up to one year after a venous stenting procedure was 81.5%, declining to 63.2% at 12–24 months. Furthermore, they reveal that primary-assisted patency and secondary patency rates at 24 months and beyond were 72.7% and 76.6%, respectively.
The team also conducted subgroup analyses, in which they found no significant difference for pooled secondary patency rates when comparing the malignant and benign subgroups. However, they note that GRADE analysis determined the certainty of evidence for all outcomes to be “very low”.
“Stenting is an effective intervention for benign and malignant stenosis of the superior vena cava, subclavian, and brachiocephalic veins,” Chawla, Zhang, Gwozdz and colleagues conclude. They reiterate that primary patency rates were “good” up to one year but declined after this time point. “Importantly,” the authors continue, “the results suggest that reintervention before in-stent thrombosis significantly increases patency rates.”
Chawla, Zhang, Gwozdz et al note that there is a lack of high-quality evidence related to venous stenting outcomes, which necessitates further research. In particular, they stress that the merits of surveillance and reintervention programmes should be explored in the interest of bettering outcomes. “This review suggests that systematised strategies to monitor and follow up patients may help optimise long-term patency,” they write.
In the discussion of their findings, Chawla, Zhang, Gwozdz and colleagues acknowledge certain limitations of their systematic review and meta-analysis. They note, for example, that the 39 included studies comprised 36 case series and three cohort studies, which they recognise might have affected data quality, and that “significant data” were not reported in the included studies, such as a lack of data on the criteria for reintervention.