A Systematic Review of the Safety and Efficacy of Stenting of the Inferior Vena Cava.

BACKGROUND: Stenting of the inferior vena cava (IVC) may provide benefit to patients with symptomatic obstruction, however there are no devices currently licensed for use in the IVC and systematic reviews on the topic are lacking.

METHODS: A systematic review of the literature was carried out according to PRISMA guidelines. The Medline and Embase databases were searched for studies reporting outcomes for safety and effectiveness of IVC stenting for any indication in series of 10 or more patients. The Newcastle Ottawa Score was used to assess risk of bias.

RESULTS: 33 studies were included describing 1,575 patients. Indications for stenting were malignant IVC syndrome (229 patients), thrombotic disease (807 patients), Budd-Chiari syndrome (501 patients) and IVC stenosis post liver transplantation (47 patients). The male: female ratio was 2:1 and the median age ranged from 30-61. The studies included were not suitable for formal metanalysis as 30/33 were single-centre retrospective studies with no control groups and there was considerable inconsistency in outcome reporting. There was significant risk of bias in 94% of studies. Median reported technical success was 100% (range 78-100%), primary patency was 75% (38-98%) and secondary patency was 91.5% (77-100%). Major complications were pulmonary embolism (3 cases), stent migration (12 cases) and major bleeding (15 cases) and 3 deaths in the immediate post-operative period. Most studies reported improvement in clinical symptoms but formal reporting tools were not used consistently.

CONCLUSION: The evidence base for IVC stenting consists of predominantly single-center, retrospective observational studies which have ahigh risk of bias. Nonetheless the procedure appears safe with few major adverse events, and studies that report clinical outcomes demonstrate improvement in symptoms and quality of life. Randomized controlled trials and prospective registry-based studies with larger patient numbers and standardized outcome are required to improve the evidence base for this procedure.