The need for a revolutionary second generation of venous stents are among the gaps and unmet needs currently at play in deep venous surgery, the 2025 American Venous Forum (AVF; 16–19 February, Atlanta, USA) heard.
Erin Murphy (Atrium Health’s Sanger Heart and Vascular Institute, Charlotte, USA) was talking through the most common complications she deals with in practice as she identified a series of gaps in indications for venous stenting during a combined Society for Vascular Medicine-European Vascular Forum-AVF session at the AVF’s VENOUS 2025 annual meeting.
Patients report with swelling and lack of improvement, she told the meeting, and “most of the time, if we look at why, it’s because we’re treating physiologic but not pathologic compression.” Though less common at this juncture, Murphy said, stent migration represents the most dangerous of the complications venous specialists confront. Illustrating her point with a case example where a stent has migrated into the inferior vena cava (IVC), she again highlighted the specter of compression, or lack thereof, where venogram and intravascular ultrasound (IVUS) imaging suggested compression, whereas on post-migration computed tomography (CT), there appears to be no compression. “So we have an education gap in a lot of cases,” Murphy said.
Which raised the potential for technology that might “help us differentiate that this is truly pathologic versus anatomic compression,” she said. There have been advances with the coming of dedicated venous stents, Murphy noted. But IVC stenting would seem to remain “a big gap,” with the Viafort stent (Gore) for the treatment of symptomatic IVC obstruction with or without combined iliofemoral obstruction, still under pivotal trial, “our first real big move in this direction,” she added.
What about “second-generation steps” in venous stenting? Murphy pondered. “We haven’t seen any second moves, so is there something with drug elution like they do in the arteries that we could take advantage of; is there a game changer in the field? What I’ve seen is that there’s really no push for competition right now.”
