Risk Factors For Stent Failure Research Articles

Covered stent placement for gastroduodenal artery stump hemorrhage after pancreaticoduodenectomy: long-term patency and risk factor of stent failure.

To evaluate the long-term outcomes of covered stent placement in patients with gastroduodenal artery (GDA) stump hemorrhage after pancreaticoduodenectomy (PD) and to identify risk factors of stent failure. Covered stent was placed in total of 21 patients for GDA stump hemorrhage after PD from September 2012 to March 2021. Technical and clinical success, complications, and stent patency were retrospectively evaluated. Nine relevant variables were analyzed to determine risk factors for stent failure. In 20 of 21 patients (95.2%), the GDA stump was completely excluded with covered stent placement. Immediate hemostasis was achieved in the 20 patients and rebleeding from jejunal artery occurred in one patient which was successfully embolized one day after the stent placement. There was no procedure-related complication or early mortality (<30 days). During follow-up period (median 655.5 days), stent thrombosis was found on CT in 10 patients (50.0%, 10/20) without any laboratory or CT abnormalities. One thrombosed stent migrated into the jejunum 20 months after placement. The six-month, one-year, and two-year stent patency were 81.9%, 52.9%, and 37.8%, respectively (median 620 days). The recurrence of primary malignancy was associated with stent failure (HR 5.70; 95% CI 1.18-27.76, p = 0.03). Covered stent placement is an effective and safe management of postoperative GDA stump hemorrhage. Stent failure occurred frequently (50%) but did not cause liver ischemia. Stent failure was associated with recurrence of primary malignancy. 1. Covered stent placement is an effective and safe management of postoperative GDA stump hemorrhage.2. Stent failure occurred frequently (50%) but did not cause liver ischemia.3. Stent failure was associated with recurrence of primary malignancy.

Transhepatic stent placement for malignant portal vein obstruction: Long term efficacy and factors associated with stent failure

PurposeTo evaluate the long-term efficacy of transhepatic stentplacement in patients with symptomatic malignant portal vein(PV) obstruction and to identify risk factors for stent failure. MethodsFrom April 2011 to March 2021, transhepatic stent placement was attempted in 36 patients with symptomatic malignant PV obstruction: naïve (n = 20) or recurrent tumor after surgery (n = 16). Technical success, clinical outcomes, and complications were retrospectively evaluated. Thirteen relevant variables were analyzed to determine risk factors for stent failure. ResultsStent was successfully placed in all but one patient (97.2%, 35/36). Thromboaspiration (n = 9) and jejunal variceal embolization (n = 4) were performed in same session. Symptoms related to portal hypertension were resolved in 30 of the 35 patients (85.7%). There was no procedure-related major complication. During the follow-up period (median 175 days),stentfailures occurred in 8 patients (22.9%): 7 stent thromboses within 90 days and one tumor ingrowth at 715 days after stent placement. The 1-, 6-, 12-month stent patency was 94.1%, 78.2%, and 62.6%, respectively. In multivariate analysis, the presence of PV thrombosisat the time of stent placement was associated with stent failure (HR 7.22; 95% CI 1.26–41.29, p = 0.03). ConclusionTranshepatic stentplacement is a safe and effective treatment for malignant PV obstruction. However, stent failure was common (22.9%) and mostly due to early stent thrombosis. The stent failure was associated with PV thrombosis at the time of stent placement.

Self-expanding metal ureteral stent for ureteral stricture: Experience of a large-scale prospective study from a high-volume center - Cross-sectional study

BackgroundThe management of ureteral stricture is still a challenge for urologists. The aim of this prospective study was to assess the safety and effectiveness of self-expanding metal ureteral stents (URS) in ureteral strictures. MethodsWe performed URS placement procedures for ureteral stricture from Jan 2019 to July 2020, and prospectively collect various data before and after the operation. A paired T test was used to compare continuous variables before and after surgery, binary logistic regression analysis was used to identify the independent risk predictors of surgical failure. ResultsA total of 147 patients with 157 renal units received successful placement of URS. The mean operative time was 70.0 min. After a median follow-up time of 15 months, 73.2% (115/157) of stents were kept in situ. The most common complication was hematuria (13, 8.8%), followed by urinary tract infection (11, 7.5%) and pain (8, 5.4%). The volume of hydronephrosis (67.9 ± 34.9 VS 34.9 ± 51.1 cm3, P = 0.0001), serum creatinine level (103.0 ± 54.5 VS 93.8 ± 45.1 μmol/L, P = 0.034) and blood urea nitrogen level (6.6 ± 6.7 VS 5.4 ± 2.4 mmol/L, P = 0.032) decreased significantly at last follow up when compared with baseline. Stricture of the distal ureter was an independent risk factor for stent failure (HR 1.77, 95% CI 1.15, 2.73, P = 0.009). ConclusionsURS was found to be safe and effective for ureteral strictures with a limited complications and good long-term results. For those who are not suitable for surgical reconstruction, the URS is an alternative management.

Predictors of antegrade ureteral stenting failure: a single-center experience in patients with malignant and benign ureteral obstruction.

To determine the potential predictors of antegrade ureteral stenting (AUS) failure in patients with malignant and benign ureteral obstruction. We retrospectively evaluated 116 AUS procedures performed in 80 patients for ureteral obstruction due to malignant and benign causes. Variables such as etiology for obstruction, ureter shape, previous treatment regimen, history of ileal loop diversion, and presence of percutaneous nephrostomy were recorded. Univariate and multivariate logistic regression methods were used between these variables and stent failure. Antegrade ureteral stenting was performed as single stage in 24 procedures (n: 24/116, 21%) and performed as a two-step approach after percutaneous nephrostomy in 92 procedures (n: 92/116, 79%). Ureteral stent was successfully deployed in 112 AUS procedures (n: 112/116, 96.5%). In 35 of these successful procedures, the patients were referred to our department due to prior failed retrograde ureteral stenting (RUS). Subsequent stent failure occurred in 40 procedures after a median interval of 39days. Pre-stenting percutaneous nephrostomy (PN) was a statistically significant risk factor for stent failure (p: 0.041), and age showed an inverse relationship with stent failure (p: 0.008). Complications in early (within the first 30days after procedure) and late stage occurred in a total of 17 procedures. Early complications included urinary tract infection (n: 11), stent migration (n: 3), and malposition (n: 1). Late complications (after 30days) were urinary tract infection (n: 1) and stent migration (n: 1). This study suggests that AUS can be performed effectively in both benign and malignant ureteral obstructions including cases with prior failed RUS. Two-step AUS after percutaneous nephrostomy was found to be a significant risk factor for subsequent stent failure in our study cohort.

Transhepatic stent placement for portal vein obstruction after hepatobiliary and pancreatic surgery: long-term efficacy and risk factor for stent failure.

To evaluate the long-term efficacy of transhepatic portal vein (PV) stent placement in patients with postoperative PV obstruction and to identify risk factors for stent failure. Between January 2007 and October 2019, percutaneous transhepatic PV stent placement was attempted in 60 patients with postoperative PV obstruction. Technical and clinical success, complications, and stent patency were retrospectively evaluated. Thirteen clinical variables were analyzed to determine risk factors for stent failure. Stent placement was technically successful in all patients. Thromboaspiration (n = 19) and jejunal variceal embolization (n = 7) were performed in the same session. Clinical symptoms related to portal hypertension were resolved in 54 patients (90.0%). There was no procedure-related complication. During the follow-up period (mean 630 days), stent failure occurred in 13 patients. One- and 5-year stent patency rate was 74.8% and 64.9%, respectively. The presence of a pancreatic fistula was the only independent risk factor associated with stent failure (HR 7.54; 95% CI 2.02-28.10, p = 0.003). Percutaneous transhepatic PV stent placement is a technically feasible and effective treatment for postoperative PV obstruction. The pancreatic fistula is a risk factor for stent failure. • Percutaneous transhepatic stent placement is an effective treatment to improve portal hypertension-related symptoms in patients with portal vein obstruction after hepatobiliary and pancreatic surgery. • The pancreatic fistula is an independent risk factor for portal vein stent failure.

Risk factors in the prediction of long-term patency of Resonance metallic ureteric stent in malignant ureteric obstruction.

ObjectivesCancer is the second leading cause of death globally in 2018 with an estimated 9.6 million deaths. The costs of managing malignant ureteric obstruction (MUO) is a significant burden to any healthcare system. However, the management of MUO has long been a challenge for urologists. The standard options of percutaneous nephrostomy or polymer double J stents are fraught with problems. We report a large patient series with long‐term follow‐up in the use of Resonance metallic ureteric stents to relieve MUO, and identification of risk factors associated with stent failure.Patients and methodsAll patients with MUO who were arranged to have Resonance metallic ureteric stent insertion at two university hospitals were included in this cohort study, starting from June 2011 to July 2016. Data were retrieved retrospectively. The primary outcome was the total duration of stent patency before stent failure due to malignant disease progression. Stent failure was defined as ureteric obstruction identified on imaging (functional radioisotope scan or antegrade pyelogram), acute renal failure resolved by subsequent percutaneous nephrostomy, or any other cause requiring stent removal prematurely. Secondary outcomes were identification of factors associated with stent failure, grade III or above complication, and development of a risk‐adopted model to predict metallic ureteric stent patency rates in MUO patients. Median duration of functioning metallic ureteric stent was determined with Kaplan‐Meier survival curve.ResultsA total of 124 renal units in 95 patients with MUO were eligible for the study, with a median follow‐up period of 22.9 months. About 106 (85.5%) renal units had successful metallic stent insertion, of whom 41 (33.1%) renal units ultimately progressed to ureteric obstruction despite the metallic stents, and required subsequent insertion of nephrostomies. Median duration of functioning metallic ureteric stents was 25 months. Female gender (HR 3.0, 95% CI: 1.3‐7.2, P = .014) and suspicious bladder lesion (HR 2.9, 95% CI: 1.4‐6.2, P = .005) were independent risk factors for stent failure, respectively. Stratifying patients into low (0 risk factor), intermediate (1 risk factor), and high (2 risk factors) risk groups, we found that this could predict the duration of stent patency in MUO with the metallic stents. (Low risk: 30.3 months vs intermediate group: 17.8 months vs high risk: 4.9 months, P < .001).ConclusionResonance metallic ureteral stents are able provide a median of 25 months of ureteric drainage in patients with MUO. Determining whether a patient has one or both risks factors (female gender and bladder lesion) will allow one to estimate the duration of metallic stent patency, which in turn may aid in determining cost‐effectiveness in individual patients.

MP02-10 LONG-TERM USE OF DOUBLE INTERNAL STENTS FOR EXTRINSIC MALIGNANT URETERAL OBSTRUCTION

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I (MP02)1 Apr 2020MP02-10 LONG-TERM USE OF DOUBLE INTERNAL STENTS FOR EXTRINSIC MALIGNANT URETERAL OBSTRUCTION Ziv Savin*, Haim Herzberg, Reuven Ben David, Snir Dekalo, Ishay Mintz, Yazeed Barghouthy, Ofer Yossepowitch, and Mario Sofer Ziv Savin*Ziv Savin* More articles by this author , Haim HerzbergHaim Herzberg More articles by this author , Reuven Ben DavidReuven Ben David More articles by this author , Snir DekaloSnir Dekalo More articles by this author , Ishay MintzIshay Mintz More articles by this author , Yazeed BarghouthyYazeed Barghouthy More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , and Mario SoferMario Sofer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000816.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with secondary extrinsic malignant ureteral obstruction (EMUO) seek for durable, simple and low-cost solutions of drainage. We report on long-term outcomes with double internal stents (DIS) for relief of EMUO. METHODS: DIS of 75 renal units (62 patients) presenting with EMUO were performed in 2007-2019. The procedure was done using dwelling 7 FR stents. Surveillance was performed every 3 months and stents were routinely exchanged annually. Need for permanent stents' retrieval was considered failure. Univariate and multivariate analyses were used to assess risk factors for stent failure and mortality. Kaplan-Meier estimations provided maintenance of stent patency and disease specific survival (DSS). RESULTS: Demographics and by-entry clinical data are presented in table 1. Balloon dilation was needed in 30 cases (48%). The median follow-up was 35.2 months (IQR 26.8-46.7) and the median DSS was 21 months (Range 7.1-45.5) (Figure 1). Thirty-nine patients died during the study period, 37 of them (95%) with patent stents in place. Multivariate analysis identified estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 and balloon dilation as independent predictors for mortality (HR=2.1, 95%CI=1.1-4.2, p=0.02 and HR=2.1, 95%CI=1.1-4.1, p=0.02, respectively). Six patients (10%) had stent failure due to sepsis, creatinine elevation, or intractable hematuria. The mean time to failure was 15 months. Radiation and eGFR < 45 ml/min/1.73m2 at presentation were independent risk factors for stent failure (p=0.038 and p=0.001, respectively). Stent-related side effects including irritative symptoms and hematuria were reported by 40% of patients. CONCLUSIONS: DIS provides durable relief of EMUO for long term. It represents a simple and valuable alternative to other methods of urinary diversion, avoiding the need for external tubes and contributing to improved patients quality of life. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e15-e15 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziv Savin* More articles by this author Haim Herzberg More articles by this author Reuven Ben David More articles by this author Snir Dekalo More articles by this author Ishay Mintz More articles by this author Yazeed Barghouthy More articles by this author Ofer Yossepowitch More articles by this author Mario Sofer More articles by this author Expand All Advertisement PDF downloadLoading ...

IMPACT OF LIPID RICH PLAQUE AT THE STENT EDGE ASSESSED BY OPTICAL COHERENCE TOMOGRAPHY ON EDGE RESTENOSIS AFTER EES IMPLANTATION

Stent edge restenosis due to incomplete lesion coverage is one of major risk factors for stent failure after drug-eluting stent implantation. An association between plaque type at stent edge and edge restenosis has not been evaluated yet. The aim of the present study was to assess whether there is

Ureteral Stent Failure in Pediatric Patients Under 10 Years: Occurrence and Risk Factors

To examine the occurrence of ureteral stent failure in pediatric patients aged <10 years and to determine risk factors for failure. We performed a retrospective cohort analysis of 100 patients who underwent ureteral stent insertion between January 2006 and December 2013. All patients were aged <10 years and were followed up until ureteral stent removal. Information regarding patient demographics, reason for stent insertion, duration of stent maintenance, stent diameter and length, and postoperative results was collected. Risk factors for stent failure were analyzed. Ureteral stenting was performed in 114 ureter units. The median age at stenting was 34.1 months (interquartile range [IQR], 8.1-71.2 months), and the median duration of stent maintenance was 35.0 days (IQR, 21.0-44.3 days). A 3-Fr stent was used in 39.5% of patients. Stent failure was observed in 11 ureter units (9.6%) at a median of 11.5 days (IQR, 7.8-24.5 days) after insertion, and the stent was subsequently removed. Use of a 3-Fr ureteral stent was the only risk factor for the development of stent failure; the failure rate was 20.0% with this stent diameter. Ureteral stenting was a useful procedure with a high success rate, even in patients aged <10 years. A 3-Fr ureteral stent was the only risk factor for stent failure; its substantial failure rate should be considered when deciding whether to insert a stent. Also, short-term re-evaluation after ureteral stent insertion is mandatory, especially with 3-Fr ureteral stents.

Metallic ureteral stents in malignant ureteral obstruction: short-term results and radiological features predicting stent failure in patients with non-urological malignancies

To provide short-term result of the metallic ureteral stent in patients with malignant ureteral obstruction and identify radiological findings predicting stent failure. The records of all patients with non-urological malignant diseases who have received metallic ureteral stents from July 2009 to March 2012 for ureteral obstruction were reviewed. Stent failure was detected by clinical symptoms and imaging studies. Survival analysis was used to estimate patency rates and factors predicting stent failure. A total of 74 patients with 130 attempts of stent insertion were included. A total of 113 (86.9 %) stents were inserted successfully and 103 (91.2 %) achieved primary patency. After excluding cases without sufficient imaging data, 94 stents were included in the survival analysis. The median functional duration of the 94 stents was 6.2 months (range 3-476 days). Obstruction in abdominal ureter (p = 0.0279) and lymphatic metastasis around ureter (p = 0.0398) were risk factors for stent failure. The median functional durations of the stents for abdominal and pelvic obstructions were 4.5 months (range 3-263 days) and 6.5 months (range 4-476 days), respectively. The median durations of the stents with and without lymphatic metastasis were 5.3 months (range 4-398 days) and 7.8 months (range 31-476 days), respectively. Metallic ureteral stents are effective and safe in relieving ureteral obstructions resulting from non-urological malignancies, and abdominal ureteral obstruction and lymphatic metastasis around ureter were associated with shorter functional duration.

Application of resonance metallic stents for ureteral obstruction

• To determine the effectiveness of the Resonance ureteral stent and clarify the risk factors that lead to stent failure. In the present study, we review our clinical experiences using Resonance stent in treating malignant and benign ureteral obstruction. • Nineteen patients with extrinsic malignant ureteral obstruction (n= 15) and benign stricture (n= 4) were retrospectively evaluated. • All patients had received Resonance stent insertion through antegrade or cystoscopic retrograde approaches. The pre-insertion and follow-up interventions included image studies and biochemical tests. The insertion success rate, obstruction patency rate and complications were reviewed. • For categorical variables, the chi-square test and Fisher's exact test were carried out to determine associations between variables. • The technical success rate of stent insertion was 84.6%. The mean follow-up was 5 months (range 1-10.5 months). • Five stents failed to alleviate the obstruction, and the patency rate was 77.3% (17/22). • Patients who had had previous radiation therapy had a lower ureter patency rate in comparison with non-radiation patients (50% vs 92.3% respectively, P= 0.039). • The 6- and 9-month patency rates were 81.0% with 11 stents and 27.0% with 3 stents, respectively. • The results of the present study demonstrated that malignant or benign ureteral obstruction could be treated safely and sufficiently with the Resonance metallic stent. • Careful patient selection is critical to achieve successful results. • For malignant ureteral obstruction, previous radiation therapy is a risk factor for stent failure.

Iliac and femoral arterial stents — an overview

SummarySince the introduction of open metallic stents for the treatment of peripheral arterial disease in 1987, percutaneous intravascular stent implantation has become a valuable adjunct to balloon angioplasty and a widely-accepted method of treatment. The availability of long-term data helps to define the indications for this treatment regimen and the risk factors for stent failure. With growing experience in stent therapy and other interventional techniques, new indications have been developed. Long-term vascular patency, the main goal of stent implantation, seems to depend on the characteristics of the underlying lesion. For the prevention of early stent thrombosis and neointimal hyperplasia, which are the major causes of stent failure, there are different ideas and new developments, including e.g. different stent designs, peri- and post-procedural medication, local intravascular drug therapy, intravascular brachytherapy and radiating stents. Thus, vascular stenting remains a steadily expanding field in interventional radiology.