Stenting of stenotic or occluded iliofemoral veins, superior and inferior vena cavae in children with congenital heart disease: acute results and intermediate follow up.
OBJECTIVE
To determine the short and intermediate term outcome following systemic venous stent placement in children with congenital heart disease.


BACKGROUND
Patients with congenital heart disease are at risk of stenosis or occlusion of systemic veins following indwelling lines or catheterizations. Stent dilation may ameliorate symptoms and open the vessel for use during future procedures. We report our acute and intermediate results.


METHODS
All patients with systemic venous stent placement in the iliofemoral veins, inferior or superior vena cava at our institution between 1998 and 2006 were included. Initial and the follow-up catheterization data were reviewed retrospectively.


RESULTS
70 stents were placed in 33 patients (36 vessels). Median age was 2.6 years (0.2-14.2) and weight 11.5 kg (3.8-78.7). 17/36 vessels (47%) were occluded requiring recanalization. Following stent delivery, the mean minimum vessel diameter increased from 3.1 +/- 3.2 to 7.2 +/- 3.0 mm (P < 0.001). There were no major complications. Seventeen patients and vessels had a total of 62 follow-up catheterizations, with median length of follow-up 4.1 years (0.7-9.3). During intermediate follow up, 7/17 vessels (41%) required additional intervention. Six patients had additional balloon dilation of existing stents, and one additional stent was placed. Vessels were further dilated to 8.4 +/- 3.5 mm at the last catheterization.


CONCLUSIONS
Systemic venous stents are safe and effective in recanalizing stenosed or occluded vessels. At follow-up, reocclusion can occur, however, previously placed stents can be safely recanalized if necessary. Future studies will determine if stenting is indicated in a broader population.
Frazer
Jeffrey R
JR
Rady Children's Hospital, San Diego, CA, USA.
Ing
Frank F
FF
D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects; D002404:Catheterization / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D007223:Infant; D008297:Male; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D010690:Phlebography; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology; D014689:Venous Insufficiency / Q000209:etiology / Q000628:therapy; D020246:Venous Thrombosis / Q000209:etiology / Q000628:therapy