Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis.

INTRODUCTION: Deep vein thrombosis (DVT) poses a complex challenge and often leads to postthrombotic syndrome (PTS), a debilitating complication. The emergence of venous stents offers a potential preventive avenue against this complication. This study aimed to provide consensus recommendations on the use of venous stent for DVT. MATERIALS AND METHODS: From June to July 2023, 20 internal medicine, angiology and vascular surgery, and vascular and interventional radiology experts were involved in the Delphi process. Thirty-one recommendations, categorized into three thematic areas, were rigorously evaluated: indications for stent use, stent selection and placement, and monitoring and prevention of complications. Agreement was evaluated using a Likert scale, with consensus defined as agreement by two-thirds of the participants. RESULTS: Consensus was reached for 23 (74.2%) of 31 recommendations. The agreement was centered on considerations, such as stent placement in specific acute DVT scenarios, emphasizing pivotal stent characteristics. However, there were divergences in the recommended stent length to prevent migration and stent characteristics based on iliocaval bifurcation morphology. Notably, there was no consensus on whether patients with DVT caused by a major transient risk factor need more than 3 months of anticoagulation therapy or whether aspirin should be added to anticoagulant treatment after venous stenting. CONCLUSIONS: These consensus recommendations offer practical insights into optimizing venous stent use to prevent PTS in DVT patients. Addressing the critical aspects of stent selection, placement, and postprocedural care, these recommendations contribute to clinical decision-making. The identified divergences underscore the importance of consensus and thus indicate the need for further investigation.

Management of left renal vein compression in patients presenting left gonadal vein reflux.

Background Compression of left renal vein is an atypical cause of reflux in pelvic veins resulting in pelvic varices that in turn causes frequently lower limb varices in many cases. Methods A monocentric study was undertaken to report the treatment and five-year follow up of patients presenting left renal vein compression. Embolization of refluxive gonadal/pelvic veins was performed generally as the initial procedure. Left renal vein stenting was performed in patients presenting haematuria, severe lumbar pain or persistent pelvic/lower limb varices after embolization. Results From 462 cases of left renal vein compression, 40 were treated by stenting as first procedure. Four hundred twenty-two were treated by gonadal/pelvic vein embolization and only 15 needed complementary stenting. After follow-up, all cases with haematuria had improved and lumbar pain was eliminated in 81.5%. Patients with recurrent or persistant varices were all improved. Conclusion Left renal vein stenting should be considered an effective and safe procedure, with demonstrated durable efficacy and safety and no evidence of restenosis.

Fuga de ligamento redondo / Round ligament leak

La fuga de ligamento redondo no es muy conocida. Está relacionada con el síndrome de congestión pélvica, y es más frecuente en multíparas y más evidente durante el tercer trimestre del embarazo. La flebografía pélvica nos permite realizar tanto el estudio como el tratamiento selectivo de dicha vena mediante técnica mixta de embolización.(AU)

Round ligament leak is not well known. It is related to pelvic congestion syndrome, and it is more frequent in multiparous women and more evident during the third trimester of pregnancy. Pelvic phlebography allows us to carry out both the selective study and the treatment of the vein using mixed techniques of embolization.(AU)

Consejos en el tratamiento endovascular del síndrome de May-Thurner / Tips on the endovascular treatment of May-Thurner syndrome

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Consideraciones sobre los puntos oscuros de la insuficiencia venosa pélvica / Considerations about the dark spots of pelvic venous insufficiency

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