years without widespread adoption or advancement. Novel sclerosant devices allow for simultaneous aspiration of blood and administration of sclerosant to induce a chemical ablation.


Due to the high number of patients suffering from superficial venous disease throughout the world and the desire to obtain optimal results with the least patient discomfort, it is important to constantly strive to improve on the already high-quality care offered by current techniques and technologies.


Thrombectomy and venous reconstruction In 2017, theAcute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-directed Thrombolysis (ATTRACT) trial failed to show a benefit of pharmacomechanical catheter-directed thrombolysis (CDT) in reducing post-thrombotic syndrome (PTS) compared to anticoagulation alone as first-line therapy in proximal deep vein thrombosis. However, the subgroup analyses of these patients that came in the following years showed better short-term recovery from deep venous thrombosis (DVT), reduced severity of PTS, slowed PTS progression and improved long-term quality of life in selected patients with acute iliofemoral DVT, especially after stent placement.11,12


With these discoveries,


new devices, techniques and strategies surrounding the treatment of venous thromboembolic disease have emerged in the years since the ATTRACT trial and are beginning to offer patients immediate and long-term relief from symptoms of acute and chronic DVT.


2010 2011 2012


Interventional radiology is recognized as a primary specialty by the American Board of Medical Specialties.


Venous stent reconstruction Endovascular venous stent reconstruction is now first-line therapy for chronic IVC thrombosis, with incidences reported at 4–15% in patients presenting with lower extremity DVT.13 Caval thrombosis is accompanied by multiple co-morbidities including recurrent lower extremity DVT with swelling, pain and venous ulceration. The advent of stents specifically designed for use in the venous system has enabled efficacious treatment options for various locations and causes of central venous obstruction, ranging from malignant superior vena cava syndrome to IVCF-associated caval thrombosis.14


Venous stents, designed with a balance between radial force and flexibility, must conform to the venous anatomy into which they are deployed. Several new stents that are FDA approved have accomplished this balance with diameters and lengths designed to accommodate upper and lower extremity veins as well as venae cavae.


The 12-month data from the VIVO study, a prospective, nonrandomized, international multicenter study of one such stent found freedom from 30-day major adverse event rate of 96.7% and primary patency rate of 89.9% in patients with symptomatic obstruction of one iliofemoral venous segment.15


The study also


demonstrated improvement in Venous Clinical Severity Score (VCSS) at 1 and 12 months. This stent has been FDA approved since Oct. 15, 2020.


There are also two bare-metal stents that show similar promise when used for iliocaval reconstruction. One


2013


The Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) study to determine efficacy and safety of IVC filters begins.


For more discussion of venous thrombectomy and pulmonary embolectomy, inferior vena cava filters and venous stent reconstruction, read the full article online at: bit.ly/3e2TIgm


features a closed-cell design and uniform end-to-end strength and shape. The results of the VIRTUS Safety and Efficacy of the Veniti Vici Venous Stent System [Veniti, Inc] When Used to Treat Clinically Significant Chronic Non-Malignant Obstruction of the Iliofemoral Venous Segment (VIRTUS) study demonstrates 12-month overall patency rates of 100% in patients with post-thrombotic syndrome with a large percentage of patients with clinical iliac vein compression syndrome (25%). Safety data from this cohort showed a 12-month adverse event freedom rate of 98.8%.16,17 Alternatively, the other bare- metal stent has an open-cell design. Results from the VERNACULAR study examined patients with post-thrombotic syndrome and nonthrombotic iliac vein lesions treated with this stent and showed a composite primary safety outcome of 93.5% and a primary patency rate of 88.3%. All treated lesions achieved over 50% residual stenosis at the end of the procedures, and VCSS pain score reductions in all patients at 1, 6 and 12 months with similar short- and long-term results described by Lichtenberg et al.18–20


Conclusion Venous disease patients demand clinical focus and commitment to treatment excellence. While significant


2014 2015 2016


The Accreditation Council for Graduate Medical Education approves the program requirements for the IR Residency.


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