CLINICAL STUDY: PEDIATRIC CARDIOLOGY
Reconstruction of stenotic or occluded iliofemoral veins and inferior vena cava using intravascular stents: re-establishing access for future cardiac catheterization and cardiac surgery
Frank F. Ing, MD, FACC*,
Thomas E. Fagan, MD ,
Ronald G. Grifka, MD, FACC,
Sandra Clapp, MD,
Michael R. Nihill, MD, FACC,
Mark Cocalis, MD, FACC*,
James Perry, MD, FACC*,
James Mathewson, MD, FACC* and
Charles E. Mullins, MD, FACC
* Children’s Hospital of San Diego, San Diego, California, USA
Texas Children’s Hospital, Houston, Texas, USA
Manuscript received January 19, 2000;
revised manuscript received August 10, 2000,
accepted September 26, 2000.
Reprint requests and correspondence: Dr. Frank F. Ing, Department of Pediatric Cardiology, Children’s Hospital, San Diego, 3020 Children’s Way, San Diego, California 92123
fing{at}chsd.org
OBJECTIVES
The study evaluated the safety and efficacy of stent reconstruction of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IVC).
BACKGROUND
Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations.
METHODS
Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic and 13 were completely occluded. Although guide wires were easily passed across the stenotic vessels, occluded vessels required puncture through the thrombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation.
RESULTS
Following stent placement, the mean vessel diameter increased from 0.9 ± 1.6 to 7.4 ± 2.6 mm (p < 0.05). Twenty-one of 28 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repeat catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diameter of 6.4 ± 2.0 mm. Two vessels were occluded, but they were easily recanalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented vessel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessels (87%) remained patent at follow-up thus far.
CONCLUSIONS
Stenotic/obstructed IFV and IVC may be reconstructed using stents to re-establish venous access to the heart for future cardiac catheterization and/or surgeries.
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Abbreviations and Acronyms
| | AP | = anteroposterior | | IFV | = iliofemoral vein | | IVC | = inferior vena cava |
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