Three-Year Results from the Venovo Venous Stent Study for the Treatment of Iliac and Femoral Vein Obstruction

Michael D Dake,Gerard O’Sullivan,Richard A Settlage,Michael Lichtenberg,Nicolas W Shammas,Bibombe P Mwipatayi

doi:10.1007/s00270-021-02975-2

Abstract

PurposeTo assess safety and patency of the Venovo venous stent for the treatment of iliofemoral vein obstruction.Materials and MethodsTwenty-two international centers enrolled 170 patients in the VERNACULAR study (93 post-thrombotic syndrome; 77 non-thrombotic iliac vein lesions). Primary outcome measures were major adverse events at 30 days and 12-month primary patency (freedom from target vessel revascularization, thrombotic occlusion, or stenosis > 50%). Secondary outcomes included the Venous Clinical Severity Score Pain Assessment and Chronic Venous Quality-of-Life Questionnaire assessments (hypothesis tested). Secondary observations included primary patency, target vessel and lesion revascularization (TVR/TLR), and assessment of stent integrity through 36 months.ResultsFreedom from major adverse events through 30 days was 93.5%, statistically higher than a pre-specified performance goal of 89% (p = 0.032) while primary patency at 12 months was 88.6%, also statistically higher than a performance goal of 74% (p < 0.0001). Mean quality-of-life measures were statistically improved compared to baseline values at 12 months (p < 0.0001). Primary patency at 36 months was 84% (Kaplan–Meier analysis) while freedom from TVR/TLR was 88.1%. There was no stent embolization/migration, and no core laboratory assessed stent fractures reported through 36 months. Six deaths were reported; none adjudicated as device or procedure related.ConclusionThe Venovo venous stent was successfully deployed in obstructive iliofemoral vein lesions and met the pre-specified primary outcome measures through 12 months. At 3 years, primary patency was 84%, reintervention rates were low, standardized quality-of-life and pain measures improved from baseline, and there was no stent migration or fractures.Level of EvidenceLevel 2—prospective, multicenter, controlled clinical study without a concurrent control or randomization. Pre-specified endpoints were hypothesis-tested to performance goals derived from peer-reviewed clinical literature.Registration clinicaltrials.govUnique Identifier NCT02655887.

Highlights

Iliofemoral venous obstruction, caused by anatomic vein compression or deep vein thrombosis (DVT), can lead to severe venous insufficiency and a reduction in quality-oflife
The Venovo venous stent was successfully deployed in obstructive iliofemoral vein lesions and met the pre-specified primary outcome measures through 12 months
Pre-specified endpoints were hypothesistested to performance goals derived from peer-reviewed clinical literature

Summary

Introduction

Iliofemoral venous obstruction, caused by anatomic vein compression or deep vein thrombosis (DVT), can lead to severe venous insufficiency and a reduction in quality-oflife. Compression therapy, anticoagulation with thrombolysis, catheter-directed thrombolysis, or pharmacomechanical thrombectomy do not address the underlying causes of venous obstruction and have provided mixed therapeutic results [1–3]. Bare metal stents designed for arterial use have been used to treat peripheral venous obstructions, yet few have been systematically studied in the venous system [5–7]. Dedicated venous stents for iliofemoral venous outflow obstruction have emerged over the past few years as alternatives to conservative therapy, surgery, and the use of arterial stents. The current prospective, multicenter study was designed and powered to evaluate major adverse events and primary patency of this dedicated, nitinol self-expanding, open-cell venous stent for iliofemoral obstructions through 12 months with secondary observations through 3 years

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