Patrick Muck (Cinncinatti, Ohio) provided a state of the venous stent landscape during the 2024 International Vein Congress (IVC; April 18–20) in Miami.
The TriHealth vascular surgery program director ran through the key differences between the venous-specific stents currently available and how he goes about selecting which one to deploy in specific scenarios.
Within the last four years, the Venovo (Bard), Vici (Boston Scientific), Zilver Vena (Cook), Abre (Medtronic) and Duo (Phillips) venous stents have all been approved for use by the US Food and Drug Administration (FDA).
“I’ve been fortunate enough to use all of the [currently available stents on the market] besides the Duo so far,” Muck told the audience. “Likely the market leader [among venous stents] is the Abre, based on the number of cases throughout the USA [where the Abre is used].”
Muck outlined a particular scenario during which he deployed the Abre in a patient who had a history of varicose vein surgery decades ago. When the patient saw Muck, multiple issues needed to be addressed, and, discovering a femoral vein occlusion, Muck and his team, using an RF wire, placed the Abre stent, with the patient doing well several years down the road following the intervention, Muck reported.
Muck then turned to the Zilver Vena stent and a post-thrombotic syndrome patient who had an iliofemoral deep vein thrombosis (DVT) during pregnancy: Nine months after giving birth, “I put a 16, 60 Zilver Vena in,” he described, reflecting that, today, he would place a longer one.
“I think both Abre and Zilver Vena have data in a subgroup analysis looking at the stent across the inguinal ligament, and, suffice to say, that the Zilver Vena is very efficacious, not only in the iliac segment but also in the common femoral areas,” Muck added.
Meanwhile, a case involving the Venovo stent, which Muck described as having “excellent patency at three years in industry sponsored trials,” saw he and colleagues treat a patient with C4b disease who had been offered superficial intervention. “Six weeks after undergoing ablation, there was no improvement and the patient was offered the Venovo stent,” he said. “What I like about all these stents is the thumb wheel for the Venovo and the Abre, and the pinch-and-pull for the Zilver Vena, which means you can place it precisely where you need to.”
The Duo stent, recently approved by the FDA, has emerged as “very flexible and very strong,” Muck continued. “At the end of the day, when it comes to placing [stents], you don’t want one that’s too short, because, if it doesn’t lock in, it may migrate. You don’t want one that’s too wide because, if it’s too wide, then, not only can you end up with pain in the short term, but perhaps this affect as well.
“Ultimately, there’s no head-to-head,” he added. “You have to individualize each patient based on their scenario as well as their IVUS. Then you can decide which stent is best for you.”
