Venous Stent Shape and Clinical Outcomes in Iliofemoral Venous Occlusive Disease

The American Venous Forum Journal Club, Venous Confluence, takes on a question that has followed dedicated venous stents since they first came to market: does an elliptical stent shape at compression points hurt patency or clinical outcomes? The session reviews two papers on stent geometry in iliofemoral venous occlusive disease. It presents a post hoc IVUS core lab analysis from the VIVO-US Zilver Vena study, showing that stenting lowered the median lumen aspect ratio from 2.0 to 1.4 and that the improvement tracked with better VCSS scores. It also reviews a retrospective single-center study of 127 limbs, where more than 75% of stents became elliptical at the May-Thurner point or under the inguinal ligament, with no link between shape and occlusion.

The panel then discusses what this means in practice: high-pressure pre-dilation, consistent stent sizing, longitudinal stiffness and stent end placement, in-stent luminal buildup, migration, and when to reintervene on a compressed stent. Their shared conclusion is that elliptical deformation is expected rather than a failure, and that IVUS area gain relative to the reference vessel matters more than roundness. CME credit is available.