Vol. 8, Issue 3, Part A (2024)

Background: Because arterial stenting across joints is not advised due to the reduced long-term patency, there is a higher risk of in-stent localized neo-intimal hyperplasia and the potential for stent breakage or compression from joint motion. Unlike arterial stenting, braided stainless stents can be safely inserted across the inguinal crease into the venous system without increasing the risk of stent fractures, external compression constriction, localized development of severe in-stent restenosis, or compromised long-term patency. Stents crossing the inguinal ligament is a contentious topic at the moment, though. Some recommendations advise against it, while others advise crossing the inguinal ligament if necessary to guarantee proper flow. The aim of this study was to evaluate the primary patency of stents that terminated above the inguinal ligament with stents that continued below the inguinal ligament.

Methods: This is a prospective multicenter study done on 30 patients (20 female, age 50.0±12.0 years), 19 malignant patients (63.3%) with 17 venous stents extended below the inguinal ligament represented at Tanta, Menofia and Galway university hospitals during the period from (May 2020) to (April 2023). During the 6-month follow-up period, the distal extension of venous stents was assessed by its patency. According to improvements in their VCSS and CEAP scores, the patients were evaluated.

Results: At one month, three months, and six months follow up periods, the supra-inguinal stents patency rate was 100%, 100%, and 90% consecutively. The infra-inguinal stents patency was 93.8% at 1 month, 87.5% at 3 months, and 93.3% at 6 months. In both groups, the median preoperative VCSS score was 18 (18 to 20). In infra-inguinal group, the median postoperative VCSS score become 7 (7 to 12) but in supra-inguinal group, the median postoperative VCSS score become 7 (7 to 8). There is no significant difference in VCSS score improvement in both groups (P=.134).

Conclusion: There was no significant difference in outcomes and clinical data in patients who received stents inferior to the inguinal ligament and patients who received stents superior to the inguinal ligament.