CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1691–1698 | Cite as

Antiplatelet Therapy is Associated with Stent Patency After Iliocaval Venous Stenting

  • Masayuki Endo
  • Younes Jahangiri
  • Masahiro Horikawa
  • John A. Kaufman
  • Ryan C. Schenning
  • Kenneth J. Kolbeck
  • Robert E. Barton
  • Yasufumi Ohuchi
  • Keng Wei Liang
  • Khashayar FarsadEmail author
Clinical Investigation Venous Interventions
Part of the following topical collections:
  1. Venous Interventions



To examine the effectiveness of antithrombotic medications to prevent venous stent malfunction for iliocaval occlusive disease.

Materials and Methods

A retrospective analysis was performed on 62 patients who underwent technically successful endovascular iliocaval stent placement between May 2008 and April 2017. Clinical records were reviewed for demographic information, procedure details, post-stenting antithrombotic prophylaxis and stent patency on follow-up. Stent malfunction was defined as > 50% stenosis or occlusion at follow-up. Risk factors for stent malfunction were assessed with univariable and multiple Cox proportional hazard models.


The median follow-up period was 11.6 months (range 0.1–76.4). Overall primary and secondary cumulative patency rates at 12 months were 70.0% and 92.4%, respectively. After stent placement, 97% of patients received anticoagulation with warfarin, enoxaparin or a factor Xa inhibitor. In addition, 61% received antiplatelet prophylaxis with aspirin, clopidogrel or a combination. In multiple Cox regression analysis, post-stenting antiplatelet use remained significantly associated with primary stent patency (HR = 0.28, P = 0.022).


After iliocaval venous stenting, stent patency was best predicted by concomitant antiplatelet and anticoagulation therapy rather than anticoagulation alone. This novel finding warrants further research underlying mechanisms leading to venous stent thrombosis, and has implications for optimal medical management after venous stenting.


Venous stent Iliocaval Patency Antithrombotic prophylaxis Antiplatelet 



We thank Anantnoor Brar for her assistance with data gathering.

Compliance with Ethical Standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

The study is approved by the Institutional Review Board (IRB) of Oregon Health and Science University.


  1. 1.
    DeRubertis BG, Alktaifi A, Jimenez JC, Rigberg D, Gelabert H, Lawrence PF. Endovascular management of nonmalignant iliocaval venous lesions. Ann Vasc Surg. 2013;27(5):577–86.CrossRefGoogle Scholar
  2. 2.
    Murphy EH, Johns B, Varney E, Raju S. Endovascular management of chronic total occlusions of the inferior vena cava and iliac veins. J Vasc Surg Venous Lymphat Disord. 2017;5(1):47–59.CrossRefGoogle Scholar
  3. 3.
    de Graaf R, de Wolf M, Sailer AM, van Laanen J, Wittens C, Jalaie H. iliocaval confluence stenting for chronic venous obstructions. Cardiovasc Interv Radiol. 2015;38(5):1198–204.CrossRefGoogle Scholar
  4. 4.
    Nicolaides A, Kakkos S, Eklof B, Perrin M, Nelzen O, Neglen P, Partsch H, Rybak Z. Management of chronic venous disorders of the lower limbs—guidelines according to scientific evidence. Int Angiol. 2014;33(2):87–208.PubMedGoogle Scholar
  5. 5.
    Nazarian GK, Bjarnason H, Dietz CA Jr, Bernadas CA, Hunter DW. Iliofemoral venous stenoses: effectiveness of treatment with metallic endovascular stents. Radiology. 1996;200(1):193–9.CrossRefGoogle Scholar
  6. 6.
    Raju S, Hollis K, Neglen P. Obstructive lesions of the inferior vena cava: clinical features and endovenous treatment. J Vasc Surg. 2006;44(4):820–7.CrossRefGoogle Scholar
  7. 7.
    Hartung O, Loundou AD, Barthelemy P, Arnoux D, Boufi M, Alimi YS. Endovascular management of chronic disabling ilio-caval obstructive lesions: long-term results. Eur J Vasc Endovasc Surg. 2009;38(1):118–24.CrossRefGoogle Scholar
  8. 8.
    Knipp BS, Ferguson E, Williams DM, Dasika NJ, Cwikiel W, Henke PK, Wakefield TW. Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome. J Vasc Surg. 2007;46(4):743–9.CrossRefGoogle Scholar
  9. 9.
    Ahmed O, Ng J, Patel M, Ward TJ, Wang DS, Shah R, Hofmann LV. Endovascular stent placement for May–Thurner syndrome in the absence of acute deep vein thrombosis. J Vasc Interv Radiol. 2016;27(2):167–73.CrossRefGoogle Scholar
  10. 10.
    Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg. 1995;21(4):635–45.CrossRefGoogle Scholar
  11. 11.
    Malik N, Banning AS, Belger M, Fakhouri W, Graham-Clarke PL, Banning A, Baumbach A, Blackman DJ, de Belder A, Lefevre T, Stables R, Zaman A, Gershlick AH. A risk scoring system to predict coronary stent thrombosis. Curr Med Res Opin. 2017;33(5):859–67.CrossRefGoogle Scholar
  12. 12.
    Alsidawi S, Effat M, Rahman S, Abdallah M, Leesar M. The role of vascular imaging in guiding routine percutaneous coronary interventions: a meta-analysis of bare metal stent and drug-eluting stent trials. Cardiovasc Ther. 2015;33(6):360–6.CrossRefGoogle Scholar
  13. 13.
    Mahnken AH, Thomson K, de Haan M, O’Sullivan GJ. CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Interv Radiol. 2014;37(4):889–97.Google Scholar
  14. 14.
    Raju S, Neglen P. Percutaneous recanalization of total occlusions of the iliac vein. J Vasc Surg. 2009;50(2):360–8.CrossRefGoogle Scholar
  15. 15.
    von Bruhl ML, Stark K, Steinhart A, Chandraratne S, Konrad I, Lorenz M, Khandoga A, Tirniceriu A, Coletti R, Kollnberger M, Byrne RA, Laitinen I, Walch A, Brill A, Pfeiler S, Manukyan D, Braun S, Lange P, Riegger J, Ware J, Eckart A, Haidari S, Rudelius M, Schulz C, Echtler K, Brinkmann V, Schwaiger M, Preissner KT, Wagner DD, Mackman N, Engelmann B, Massberg S. Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. J Exp Med. 2012;209(4):819–35.CrossRefGoogle Scholar
  16. 16.
    Langwieser N, Bernlochner I, Wustrow I, Dirschinger RJ, Jaitner J, Dommasch M, Bradaric C, Laugwitz KL, Ibrahim T. Combination of factor Xa inhibition and antiplatelet therapy after stenting in patients with iliofemoral post-thrombotic venous obstruction. Phlebology. 2016;31(6):430–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Masayuki Endo
    • 1
  • Younes Jahangiri
    • 1
  • Masahiro Horikawa
    • 1
  • John A. Kaufman
    • 1
  • Ryan C. Schenning
    • 1
  • Kenneth J. Kolbeck
    • 1
  • Robert E. Barton
    • 1
  • Yasufumi Ohuchi
    • 2
  • Keng Wei Liang
    • 1
  • Khashayar Farsad
    • 1
    Email author
  1. 1.Charles T. Dotter Department of Interventional Radiology, Dotter Interventional InstituteOregon Health and Science UniversityPortlandUSA
  2. 2.Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of MedicineTottori UniversityYonagoJapan

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