This episode pairs a 22-year Stanford retrospective of 1,094 lower extremity venous stents in 406 patients with the 3-year VIVO IDE trial of the Zilver Vena stent, and asks whether crossing the inguinal ligament actually dooms a venous stent.
- Where the Rule Came From: The recommendation against stenting below the lesser trochanter traces back to citations from 1987 and 1997 that evaluated surgical bypass grafts, not endovascular stents.
- Apples to Oranges: Mabud reports 57.3% five-year primary patency against VIVO's 90.3% three-year ultrasound patency, but Mabud counts any reintervention as failure. Its five-year assisted patency is also 90.3%.
- Below the Ligament: Stents extended below the ligament in 32.5% of VIVO patients, with statistically identical 30-day safety (96.2% vs 96.9%, P = .76) and no significant patency difference at 12 months (83.3% vs 93.0%, P = .31). The higher reintervention rate tracked with worse baseline disease: lesions averaged 15.6 cm versus 7.1 cm and were four times more likely to be fully occlusive.
- Hardware Is Not the Problem: Across roughly 1,459 stents spanning 30 years of technology, including stents landed in the common femoral, femoral, and popliteal veins, there were zero reported fractures.
- Practical Rule: Normal vein to normal vein, securing at least 8 mm of healthy inflow, downsizing to 10 to 12 mm infra-inguinally. Post-stent, a DOAC alone is sufficient, since adding aspirin increases bleeding without improving patency.
Tune in to learn why inflow quality, not an anatomic landmark, should decide where your stent lands.
This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.
Mabud TS, Cohn DM, Arendt VA, et al. Lower extremity venous stent placement: a large retrospective single-center analysis. J Vasc Interv Radiol. 2020;31(2):251-259.
Comerota AJ, Gagne P, Brown JA, Segbefia E, Hofmann LV; VIVO Clinical Study Investigators. Final 3-year study outcomes from the evaluation of the Zilver Vena venous stent for the treatment of symptomatic iliofemoral venous outflow obstruction (the VIVO clinical study). J Vasc Interv Radiol. 2024;35(6):834-845.