Complications of Venous Stenting: Now that it happened, What to do?

This Vein and Lymphatic University Grand Rounds session is moderated by Dr. Khanjan Nagarsheth (United States) with discussion led by Dr. Jose Almeida (United States), Dr. Steve Abramowitz and featured speaker Dr. Suat Doganci (Turkey) on the clinical problem of venous stenting complications, with emphasis on thrombotic stent failure and in-stent occlusion. The panel reviews a practical framework for analyzing occlusion mechanisms (inflow, outflow, device/technical, and hematologic factors), contrasts early versus chronic occlusions, and discusses real-world reintervention strategies including thrombolysis/thrombectomy, venoplasty, restenting/extension, hybrid conversion, and emerging in-stent debulking technologies (with embolic protection). The session also highlights surveillance and anticoagulation considerations after complex reconstructions. Key learning points: • Stent patency depends on treating both inflow (CFV/profunda) and outflow (iliocaval) disease; untreated inflow disease is a common cause of early occlusion. • Early occlusions (less than 2 weeks) may be amenable to thrombolysis/thrombectomy plus correction of the underlying technical or flow-limiting lesion. • Chronic occlusions often involve in-stent fibrosis; debulking approaches may preserve lumen better than balloon-only relining. • Wallstent end tapering and wire-related balloon rupture can complicate reintervention and should inform device selection and landing strategy. • Anticoagulation strategy should be individualized to inflow quality, thrombotic risk, and surveillance findings. Practical, complication-focused decision-making for clinicians managing complex iliocaval reconstructions.