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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.

Abbreviations and Acronyms   AP = anteroposterior   IFV = iliofemoral vein   IVC = inferior vena cava

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