title: A modification of iliac vein stent technique.
abstract: BACKGROUND
  Iliac vein stenting has emerged as a promising new technology to address a wide spectrum of advanced chronic venous disease. Wallstent™ has been the commonest stent type used in reported experience. It has excellent long-term patency with good clinical outcome, but is prone to compression/migration of the upper end of the stent requiring reinterventions. Extension of the stent into the vena cava to avoid this problem may render subsequent contralateral stenting technically difficult and possibly contribute to partial jailing of contralateral flow. A technical modification in which a Gianturco Z stent™ is added to the upper end of the Wallstent stack that may ameliorate some of these concerns is described.
  
  
  METHODS
  The details of technique, complications, patency, and reinterventional rate of the Z stent modification in 217 limbs followed up to 24 months are reported.
  
  
  RESULTS
  Cumulative primary and secondary patency (24 months) were 69% and 93%, respectively. Eight stents were occluded and lysis restored patency in 6 patients. There was no mortality. Deep venous thrombosis (<30 day) occurred in 4% of patients similar to the incidence in native disease. Reinterventions were required in 11% of patients over the follow-up period to correct stent malfunction. Most of these (23/25) were related to the Wallstent tail of the combination stent stack. The Z stent modification provides increased radial strength at the iliac-caval junction which is a choke point. The Z stent modifications greatly facilitate staged or sequential bilateral stenting technique and may reduce the incidence of reinterventions related to retraction or compression of the upper end commonly seen with prior Wallstent experience.
  
  
  CONCLUSIONS
  The Z stent modification appears to improve functionality of the stent stack at the upper end and greatly facilitates simultaneous or staged bilateral stenting technique.
authors.affiliation: The Rane Center at St. Dominic, Jackson, MS. Electronic address: rajumd@earthlink.net.
authors.forename: Seshadri
authors.initials: S
authors.lastname: Raju
authors.affiliation: The Rane Center at St. Dominic, Jackson, MS.
authors.forename: Mark
authors.initials: M
authors.lastname: Ward
authors.affiliation: The Rane Center at St. Dominic, Jackson, MS.
authors.forename: Orla
authors.initials: O
authors.lastname: Kirk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D019233:Retreatment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014652:Vascular Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000209:etiology / Q000628:therapy; D055815:Young Adult