Role of laser ablation in recalcitrant instent restenosis post iliofemoral venous stenting

Instent restenosis (ISR) represents the most common reason for recurrent symptoms requiring reintervention in patients who have undergone venous stenting for chronic iliofemoral venous obstruction. Treatment of ISR requires stent angioplasty typically using angioplasty balloons equal to or larger than the rated diameter of the stent. At times this does not yield the required result, and in these patients, utilization of a laser catheter supported by an angled sheath is helpful to ablate the ISR or make it more amenable to repeat balloon angioplasty. The authors report their experience with this technique for 18 patients with recurrent symptoms impacting quality of life as a result of recalcitrant ISR in this retrospective review of contemporaneously entered electronic medical record data. 12 (67%) limbs underwent laser ablation only, while 6 (33%) limbs underwent additional angioplasty post laser ablation. Post intervention for ISR, at 12 months, the venous clinical severity score improved from 5 to 3.5 (P = .0005) and the VAS pain score went from 7 to 5 (P = .0005). At 10 months, primary patency was 87% and primary assisted patency was 100%. There were no stent occlusions. Laser ablation of recalcitrant instent restenosis in patients presenting with recurrent chronic iliac venous obstruction post iliofemoral venous stenting is a safe and effective option. Corroboration from larger studies is warranted.