News | November 22, 2010

Physicians Disagree Over Use of Venous Stents

November 22, 2010 – At the VEITHsymposium, physicians debated whether stents are usually required in the endovenous treatment of chronic venous disease.

Seshadri Raju M.D., professor emeritus of surgery at the University of Mississippi Medical Center in Flowood, Miss., said that detectable iliac vein stenosis is present in more than 90 percent of cases of chronic venous disease (CVD).

He said that in about a third of cases, the obstruction is the sole pathology. In the other two-thirds, associated reflux is present, making it difficult to diagnose iliac vein obstruction. Stent technology has made it easier to correct the obstructive component. Nearly 75 percent of patients report significant improvement in limb pain, and roughly two-thirds of patients are completely relieved of pain over five years. Frequent usage of stenting has resulted in a near total endovenous practice with a radical decline in the need for open surgery.

But Gregory L. Moneta, M.D., chief professor of surgery at the division of vascular surgery at Oregon Health and Science University disagrees.

“For now, stents are best avoided in the endovascular treatment of venous disease,” he said. “However, some perspective is in order. The surgeons in Jackson are now telling us that, after years of previously telling us we need to correct venous reflux, all of a sudden, deep and saphenous reflux is not really important. After years of telling us we need to carefully evaluate venous hemodynamics all of a sudden venous hemodynamics do not matter—only IVUS (intravascular ultrasound) images matter. We are being asked to completely reassess our concepts of venous pathophysiology, our ability to quantify perturbations of venous physiology and our treatments for chronic venous disease, and adopt and widely utilize very expensive technology.”

According to Moneta, use of stents in the venous system has, of late, received a great deal of publicity with no convincing evidence that they are required to facilitate favorable outcomes in patients with venous disorders.

Surgeons from Jackson, Miss., drew the following conclusions:

• Venous stenting results in “major symptom relief in patients with chronic venous disease. However, there is no consistently reflected hemodynamic improvement reflected by conventional measurement.
• Iliac venous stenting alone is sufficient to control symptoms in the majority of patients with combined outflow obstruction and deep reflux.
• Venous stents can be safely placed in the venous system across the inguinal crease with no risk of stent fractures, narrowing due to external compression, focal development of severe in-stent re-stenosis and no effect on long term patency.

“There is nothing wrong with reassessing old concepts; that is one of the things facilitating progress,” Moneta said. “On the other hand, data that comes primarily from a single center, by unblinded observer, with a financial interest in the procedures they are advocating, cannot serve as justification for a complete change in concept of treatment of venous disease no matter how much we respect these observers, their contributions to the venous literature, and no matter how much we would like to believe that the data from Jackson can extrapolated to those of us practicing in other locations.”

“To adopt the practice pattern of widespread venous stenting and totally change established concepts of chronic venous disease, we need to be guided by blinded, clearly unbiased observers level 1 data of efficacy for patient oriented outcomes that matter. This must be in the context of a proper randomized trial,” Moneta said. “We also need cost data, effectiveness data and an analysis of the potential impact on the health care system. Only then will we will be able to properly evaluate the role of stents in the treatment of venous disease.”

For more information:

Related Content

Biotronik Studies Demonstrate Efficacy of Minimizing Metal Burden in SFA Therapy
News | Stents Bare Metal| September 22, 2017
Physicians demonstrated that reducing metal burden in superficial femoral artery (SFA) therapy could effectively reduce...
Tryton Side Branch Stent Recognized With Premier Technology Breakthrough Award
News | Stents Bifurcation| September 21, 2017
September 21, 2017 — Cardinal Health and Tryton Medical Inc.
Abbott will end sales of the Absorb bioresorbable stent scaffold, pulling it off the market September 14, 2017.
Feature | Stents Bioresorbable| September 08, 2017 | Dave Fornell
September 8, 2017 — Abbott Vascular has announced it will end commercial sales of its Absorb bioresorbable vascular s
Biotronik's Orsiro Drug-Eluting Stent Outperforms Xience in BIOFLOW-V Trial
News | Stents Drug Eluting| September 01, 2017
September 1, 2017 — Biotronik recently announced data from the BIOFLOW-V randomized trial comparing Orsiro and Xience
FDA Approves Six-Month Primary Endpoint for Tack Endovascular System in Below the Knee Disease
News | Stents Peripheral| July 14, 2017
Intact Vascular Inc. announced the U.S. Food and Drug Administration (FDA) approved an Investigational Device Exemption...
Onyx DES 2.0 mm stent meets primary endpoints in small vessels
News | June 12, 2017
June 12, 2017 – The Medtronic Resolute Onyx Drug-Eluting Stent (DES) met its primary endpoint of target lesion failur
First Pennsylvania Patient Treated in LEADERS FREE II Trial of BioFreedom Drug-Coated Stent
News | Stents Drug Eluting| May 12, 2017
PinnacleHealth CardioVascular Institute enrolled the first patient in Pennsylvania in a trial assessing the safety and...
Resolute Onyx DES, drug eluting stent, medtronic, gains FDA approval
Technology | Stents Drug Eluting| May 01, 2017
May 1, 2017 — The U.S.
Sponsored Content | Videos | Stents Drug Eluting| May 01, 2017
This video, provided by Medtronic, demonstrates the Resolute Onyx coronary stent.
Overlay Init