Long-term clinical outcomes of self-expandable closed-cell and open-cell stents for endovascular reconstruction of the inferior vena cava

Summary: Background: Inferior vena cava (IVC) obstruction may cause acute descending thrombosis, post-thrombotic syndrome, or chronic venous insufficiency. Endovascular IVC stent reconstruction may improve clinical outcomes but the risk of patency loss is considerable. Stent design might impact the patency rates, but data comparing the performance of open-cell versus closed-cell IVC stents are lacking. Patients and methods: We investigated long-term clinical outcomes of 130 patients (median age 39 years, 26% women) who underwent endovascular reconstruction of an IVC obstruction with self-expandable nitinol stents of whom 52 (40%) received closed-cell stents and 78 (60%) open-cell stents between 2012 and 2024 in two Swiss university hospitals. At baseline, 41 (32%) patients presented with acute iliocaval thrombosis, 84 (65%) with post-thrombotic syndrome, and 5 (4%) with non-thrombotic IVC compression. Overall, kissing iliocaval Y-stent reconstruction was performed in 106 patients (82%). Clinical outcomes included patency rates and sustained clinical success defined as Villalta score <5 points and absence of venous stent occlusion or any re-intervention. Results: Median follow-up after endovascular stent reconstruction was 37 months (Q1–Q3: 18 to 68). Primary and secondary patency rates at 24 months were 62.1% (95% CI 50.0–77.2) and 93.8 (95% CI 87.3–100) for closed-cell stents and 79.6% (95% CI 70.3–90.0) and 100% (95% CI 100–100) for open-cell stents, respectively. Sustained clinical success was observed in 22 (42%) patients from the closed-cell group and in 55 (71%) patients from the open-cell stent group. Conclusions: In patients undergoing endovascular IVC reconstruction, self-expandable open-cell nitinol stents might offer favorable patency and clinical outcomes during follow-up.