Investigation of adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents in the iliac vein: insights into developing a better iliac vein stent
We analyzed the adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents for the treatment of iliac venous thromboembolism and investigated their relationships with the anatomical features of the iliac vein, to gain insights into the development of a better iliac vein stent. Reports of adverse events following the use of stents in the iliac vein were retrieved from the Manufacturer and User Facility Device Experience (MAUDE) database that contain suspected device-associated complications reported to the Food and Drug Administration. Data from 2006 to 2016 were investigated. The literature analysis was also conducted using PubMed, Cochrane Library, EMBASE, and Web of Science focusing on English articles published up to 4 October 2016. The analysis of 88 adverse events from the MAUDE database and 182 articles from the literature revealed that a higher number of adverse events had been reported following the use of arterial stents in the iliac vein compared to CE-marked iliac vein stents. While stent migration and shortening were reported only for the arterial stents, stent fracture and compression occurred regardless of the stent type, even though a vein does not pulsate. A study of the anatomical features of the iliac vein implies that bending, compression, and kink loads are applied to the iliac vein stents in vivo. For designing, developing, and pre-clinical testing of stents intended for use in the iliac vein, the above mechanical load environments induced by the anatomical features should be considered.
KeywordsVenous thromboembolism Iliac vein stent Adverse event Off-label use Iliac vein anatomy
This research was partially supported by the Research on Regulatory Science of Pharmaceuticals and Medical Devices from Japan Agency for Medical Research and development, AMED (no. 17mk0102087h0001), and Subsidy Program for Development of International Standards for Evaluation of Innovative Medical Devices and Regenerative Medicine Products, 2017 from Ministry of Health, Labour and Welfare, Japan.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Heit JA, Cohen AT, Anderson FA. Estimate annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. Blood. 2005;106:910.Google Scholar
- 24.Bozkaya H, Cinar C, Ertugay S, Korkmaz M, Guneyli S, Posacioqlu H, Parildar M. Endovascular treatment of iliac vein compression (May–Thurner) syndrome: angioplasty and stenting with or without manual aspiration thrombectomy and catheter-directed thrombolysis. Ann Vasc Dis. 2005;8:21–8.CrossRefGoogle Scholar
- 35.Mahnkern AH, Thomson K, de Haan M, O’Sullivan GJ. CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Interv Radiol. 2014;37:889–97.Google Scholar