REGULAR CONTENT
Final ID
556
Type
Original Scientific Research-Oral or Pos
Authors
G O'Sullivan1, A Ahmed2
Institutions
1University College Hospital, Galway, Ireland, 2Assiut University Hospital, Assiut, Egypt
Purpose
PURPOSE: Cancer patients are at high risk for venous thromboembolic disease. We assess the complex management and treatment of venous outflow obstruction (VOO) with the VICI VENOUS STENT® in a small cohort of patients with malignant and metastatic disease.
Materials & Methods
MATERIALS AND METHODS: Single institution, retrospective study of cancer patients who presented with gross lower limb swelling and who consented for palliative care with stenting. Preoperative imaging involved duplex ultrasound (DUS) for diagnosis, vessel access, and guidance; computed tomography pulmonary angiography (CTPA) and indirect CT venography (CTV) to rule out pulmonary embolism and right ventricular dilatation, and the possible need for an inferior vena cava (IVC) filter. Intraoperative use of systemic heparin followed by catheter-directed thrombolysis (CDT) or CDT with pharmaco-mechanical thrombectomy, pre-stenting angioplasty, stenting, post-stenting dilatation, and assessment by venogram, intravenous ultrasound, or CTV.
Results
RESULTS: Five patients (median age: 57 years, range: 40–83 years) with malignant disease and lower limb swelling underwent venous stenting with the VICI VENOUS STENT at a university hospital in Ireland and were followed up to 8 months. VOO was due to lymph node compression (n = 2), multiple factors including May-Thurner Syndrome (n = 2), and tumor compression (n = 1). Eight stents were placed: 4 in the iliocaval (n = 2), 3 in the iliofemoral (n = 2), and 1 in the IVC (n = 1). There were no stent complications on DUS or CTV and all patients complied with their anticoagulation regimens. Two patients had no recurrence of VOO or reintervention. One patient experienced stent occlusion at 8 months due to recurrent cancer and underwent successful repeat dilatation without repeat stenting of the lesion. One patient was lost to follow-up prior to the 1-month postoperative visit, and one patient died of metastatic disease shortly after the procedure.
Conclusions
CONCLUSIONS: Additional patients will be treated and described. Effective management and treatment of VOO in cancer patients is possible with a regimented approach and an understanding of the care pathway.
Final ID
556
Type
Original Scientific Research-Oral or Pos
Authors
G O'Sullivan1, A Ahmed2
Institutions
1University College Hospital, Galway, Ireland, 2Assiut University Hospital, Assiut, Egypt
Purpose
PURPOSE: Cancer patients are at high risk for venous thromboembolic disease. We assess the complex management and treatment of venous outflow obstruction (VOO) with the VICI VENOUS STENT® in a small cohort of patients with malignant and metastatic disease.
Materials & Methods
MATERIALS AND METHODS: Single institution, retrospective study of cancer patients who presented with gross lower limb swelling and who consented for palliative care with stenting. Preoperative imaging involved duplex ultrasound (DUS) for diagnosis, vessel access, and guidance; computed tomography pulmonary angiography (CTPA) and indirect CT venography (CTV) to rule out pulmonary embolism and right ventricular dilatation, and the possible need for an inferior vena cava (IVC) filter. Intraoperative use of systemic heparin followed by catheter-directed thrombolysis (CDT) or CDT with pharmaco-mechanical thrombectomy, pre-stenting angioplasty, stenting, post-stenting dilatation, and assessment by venogram, intravenous ultrasound, or CTV.
Results
RESULTS: Five patients (median age: 57 years, range: 40–83 years) with malignant disease and lower limb swelling underwent venous stenting with the VICI VENOUS STENT at a university hospital in Ireland and were followed up to 8 months. VOO was due to lymph node compression (n = 2), multiple factors including May-Thurner Syndrome (n = 2), and tumor compression (n = 1). Eight stents were placed: 4 in the iliocaval (n = 2), 3 in the iliofemoral (n = 2), and 1 in the IVC (n = 1). There were no stent complications on DUS or CTV and all patients complied with their anticoagulation regimens. Two patients had no recurrence of VOO or reintervention. One patient experienced stent occlusion at 8 months due to recurrent cancer and underwent successful repeat dilatation without repeat stenting of the lesion. One patient was lost to follow-up prior to the 1-month postoperative visit, and one patient died of metastatic disease shortly after the procedure.
Conclusions
CONCLUSIONS: Additional patients will be treated and described. Effective management and treatment of VOO in cancer patients is possible with a regimented approach and an understanding of the care pathway.