Stent migration after treatment of an acute ilio-femoral thrombus or venous obstruction is “rare but may be underreported”, with the majority of reported cases being shorter, smaller diameter stents. This is the main conclusion of a systematic review published in the Journal of vascular surgery: venous and lymphatic disorders.
Authors Mohamed Hosny Sayed (Guys & St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK) 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 remedy this scarcity of literature, Sayed et al performed a systematic review, with the specific aim of identifying the number of cases reported in the published literature, as well as recognizing the associated risk factors and outcomes of venous stenting.
The authors report that all patients included in this review were over the age of 16 and had reported cases of thoracic central venous stent placement complicated by primary site dislodgement or migration to cardiopulmonary structures. (right heart, pulmonary artery).
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 the stent used. The mean age of 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 report that in 85% of migrated stent events removal was attempted with 56% via an endovascular approach. In these cases, the immediate result was 100% regardless of recovery approach, however, Sayed et al point out that stent migration can result in immediate death, preventing any attempt at recovery.
The review found that no migrated stents were reported to be longer than 100mm, with 38 of 46 (82.6%) reported to be less than 60mm, and only 3.6% of migrated reported involved stents greater than 14 mm in diameter.
Sayed and colleagues conclude that venous stent migration appears to be a rare complication of venous stenting, however, when it occurs, it has the potential to cause “significant morbidity and mortality.” The data also suggests that migration is more likely to occur with shorter (≤ 60 mm) and smaller diameter (≤ 14 mm) stents, with the combination being the most common. “This adds weight to the important role that appropriate sizing of stents in treatment can play in preventing this catastrophic complication,” notes lead author Stephen Black (St Thomas’ Hospital, King’s College London, London, UK ), addressing Vein News.
Looking ahead, Sayed and colleagues write that “more formal data collection would provide a more accurate reflection of incidence,” especially since this complication is “definitely underreported,” according to Black. They point out that the data retrieved for this review was of too low quality for meaningful statistical analysis. However, the researchers also point out that “clear strategies to avoid migration must be followed to prevent this complication from occurring.” This is “strongly linked” to training and education, says Black, which he says “can help prevent patients from getting injured.”