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Abstract

Purpose:

The aim of this paper was to report our experience with arterial and venous endovascular stent placement in the thoracic outlet (TO) and review available literature.

Methods:

All patients that underwent arterial or venous stent placement in the TO between 2013 and 2020 in 5 Dutch vascular teaching-hospitals were retrospectively identified. Primary endpoint was symptomatic stent failure due to stenosis, chronic or posture dependent compression, fracture, or occlusion of the stent. Secondary endpoints were symptoms at last follow-up and re-interventions. For the literature review, we searched studies reporting on stenting in the TO.

Results:

Twenty-six patients were included with 11 arterial and 15 venous stents implanted to treat angioplasty resistant stenosis in arterial or venous TO syndrome, iatrogenic or traumatic vascular injury, radiotherapy fibrosis, or arterial dissection. Median follow-up was 19 and 14 months in the arterial and venous-group, respectively. Eight (73%) patients in the arterial, and 9 (60%) in the venous-group suffered symptomatic stent failure. Seven (64%) patients in the arterial, and 9 (60%) in the venous-group required at least 1 re-intervention. When comparing all patients with stent placement after TO decompression (TOD) to patients without, there were substantially more symptomatic stent failures and re-interventions required in the patients without TOD. Six patients (54%) in the arterial-group and 11 (73%) in the venous-group were symptom-free at last follow-up. Five articles describing 51 patients with arterial and 6 articles describing 81 patients with venous stents were included in the literature review. In the arterial-group, no TOD prior to stent placement was performed, while in the venous-group all but 1 article performed TOD prior to stent placement. Results showed comparable rates of symptomatic stent failure (24% vs 30%), and patients requiring re-interventions (29% vs 21%) between groups.

Conclusion:

Based on our multicenter series and review, stents in the TO have a considerable risk of failure, both in the venous and the arterial territory. Especially in patients without TOD: the need for re-interventions is high and half the patients eventually undergo TOD. Based on the currently available data, stenting in the TO should be applied cautiously while TOD should be considered.

Keywords

upper extremity deep vein thrombosis stents thoracic outlet syndrome vascular patency arterial venous

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References

Kröger

Santosa

Goyen

Biomechanical incompatibility of popliteal stent placement. J Endovasc Ther. 2004;11(6):686–694. doi:10.1583/04-127.1.

Fortier

Gullapalli

Mirshams

RA.

Review of biomechanical studies of arteries and their effect on stent performance. IJC Hear Vessel. 2014;4:12–18. https://doi.org/10.1016/j.ijchv.2014.04.007.

Rits

van Herwaarden

Jahrome

, et al. The incidence of arterial stent fractures with exclusion of coronary, aortic, and non-arterial settings. Eur J Vasc Endovasc Surg. 2008;36(3):339–345. doi:10.1016/j.ejvs.2008.05.005.

Jaff

White

Hiatt

, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Vasc Med. 2015;20(5):465–478. doi:10.1177/1358863X15597877

Illig

Doyle

AJ.

A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg. 2010;51(6):1538–1547. doi:10.1016/j.jvs.2009.12.022.

de Kleijn

RJCMF

Schropp

Westerink

, et al. Timing of thoracic outlet decompression after thrombolysis for primary upper extremity deep venous thrombosis: a systematic review. Ann Vasc Surg. 2020;66:654–661. doi:10.1016/j.avsg.2020.01.083.

Chen

Doornbos

Williams

, et al. Physiologic variations in venous and arterial hemodynamics in response to postural changes at the thoracic outlet in normal volunteers. Ann Vasc Surg. 2014;28(7):1583–1588. doi:10.1016/j.avsg.2014.05.003.

Colon

Westdorp

Vascular compression in the thoracic outlet. Age Dependent Normative Values in Noninvasive Testing. J Cardiovasc Surg (Torino). 1988;29(2):166–171.

Longley

Yedlicka

Molina

, et al. Thoracic outlet syndrome: evaluation of the subclavian vessels by color duplex sonography. AJR Am J Roentgenol. 1992;158(3):623–630. doi:10.2214/ajr.158.3.1739007.

10.

Allie

Hebert

CJWC

, Walker CM. Nitinol stent fractures in the SFA: the biomechanical forces exerted on the SFA provide a “stiff” challenge to endovascular stenting. Endovasc Today. 2004;7(July/August):22–34.

11.

du Toit

Lambrechts

Stark

, et al. Long-term results of stent graft treatment of subclavian artery injuries: management of choice for stable patients? J Vasc Surg. 2008;47(4):739–743. doi:10.1016/j.jvs.2007.11.009.

12.

Parodi

Schönholz

Ferreira

, et al. Endovascular stent-graft treatment of traumatic arterial lesions. Ann Vasc Surg. 1999;13(2):121–129. doi:10.1007/s100169900230.

13.

Meier

Pollak

Rosenblatt

, et al. Initial experience with venous stents in exertional axillary-subclavian vein thrombosis. J Vasc Surg. 1996;24(6):974–81discussion981. doi:10.1016/s0741-5214(96)70043-5.

14.

Patel

Marin

Veith

, et al. Endovascular graft repair of penetrating subclavian artery injuries. J Endovasc Surg. 1996;3(4):382–388. doi:10.1583/1074-6218(1996)003<0382:EGROPS>2.0.CO;2.

15.

Cohen

Rajz

Gomori

, et al. Urgent endovascular stent-graft placement for traumatic penetrating subclavian artery injuries. J Neurol Sci. 2008;272(1–2):151–157. doi:10.1016/j.jns.2008.05.016.

16.

Xenos

Freeman

Stevens

, et al. Covered stents for injuries of subclavian and axillary arteries. J Vasc Surg. 2003;38(3):451–454. doi:10.1016/s0741-5214(03)00553-6.

17.

Molina

Hunter

Dietz

CA.

Protocols for Paget-Schroetter syndrome and late treatment of chronic subclavian vein obstruction. Ann Thorac Surg. 2009;87(2):416–422. doi:10.1016/j.athoracsur.2008.11.056.

18.

Rajendran

Cai

Loa

, et al. Early outcomes using dedicated venous stents in the upper limb of patients with venous thoracic outlet syndrome: a singe centre experience. CVIR Endovasc. 2019;2(1). doi:10.1186/s42155-019-0066-0.

19.

Kreienberg

Chang

Darling

III , et al. Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome. J Vasc Surg. 2001;33(2 suppl):100–105.

20.

Stone

Scali

Bjerk

, et al. Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function. J Vasc Surg. 2010;52(1):127–131. doi:10.1016/j.jvs.2010.01.091.

21.

Molina

Hunter

Dietz

CA.

Paget-Schroetter syndrome treated with thrombolytics and immediate surgery. J Vasc Surg. 2007;45(2):328–334. doi:10.1016/j.jvs.2006.09.052.

22.

Kakkos

Gohel

Baekgaard

, et al. European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9–82. doi:10.1016/j.ejvs.2020.09.023.

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Multicenter Case Series and Literature Review on Durability of Stents in the Thoracic Outlet

Abstract

Purpose:

Methods:

Results:

Conclusion:

Keywords

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References

Supplementary Material