Systems and methods for treating venous compression/obstruction syndromes
View Patent ↗Apparatus and methods are provided for treating patients exhibiting symptoms of hypertension, isolated systolic hypertension, heart failure with preserved ejection fraction, May-Thuner Syndrome or dyspnea by diagnosing and reducing narrowing of a patient's iliac vein caused by extrinsic localized compression using a stent having circumferential differential radial stiffness and delivery catheter for aligning and deploying such stents.
1. A method of treating heart failure with preserved ejection fraction (HFpEF), May-Thuner Syndrome, or other venous compression/obstruction syndromes, the method comprising the steps of:
identifying a patient as presenting with symptoms of at least one of heart failure with preserved ejection fraction, May-Thuner Syndrome or a venous compression/obstruction syndrome;
performing a non-invasive test to assess presence of impaired iliac venous blood flow;
if the non-invasive test indicates impaired iliac venous blood flow, performing a venogram to identify an area of localized narrowing of a patient's iliac vein;
transvascularly positioning a stent having a circumferential differential radial stiffness within the patient's iliac vein;
orienting the stent so that the circumferential differential radial stiffness is aligned with the area of localized narrowing of the patient's iliac vein; and
deploying the stent within the patient's iliac vein to reduce the localized narrowing of the patient's iliac vein.
2. The method of claim 1 , wherein performing a non-invasive test comprises employing either magnetic resonance venography or computed tomographic venography.
3. The method of claim 1 , wherein performing a venogram to identify an area of localized narrowing of a patient's iliac vein comprises employing a venogram to determine a circumferential extent of an extrinsic localized compression of the patient's iliac vein.
4. The method of claim 1 , further comprising determining a diameter of the patient's iliac artery near the area of localized narrowing of the patient's iliac vein.
5. The method of claim 4 , further comprising selecting a stent suitable for use in stenting the area of localized narrowing of the patient's iliac vein, wherein the selection includes selecting a length of the stent and a circumferential differential radial stiffness sufficient to counteract a load causing the extrinsic localized compression of a patient's iliac vein when the stent is deployed.
6. The method of claim 1 , further comprising providing a delivery catheter, wherein orienting the stent comprises rotating the delivery catheter.
7. The method of claim 6 , wherein providing a delivery catheter comprises providing a delivery catheter having sufficient rigidity to transmit a torque applied at a proximal end of the delivery catheter to a distal end of the delivery catheter.
8. The method of claim 7 , further comprising providing a delivery catheter, wherein orienting the stent comprises rotating the delivery catheter.
9. The method of claim 6 , wherein the delivery catheter comprises an array of radio-opaque markers configured to facilitate angular orientation of the stent within the patient's iliac vein prior to stent deployment, when viewed under fluoroscopic guidance, such that orienting the stent comprises rotating the delivery catheter under fluoroscopic guidance.
10. The method of claim 1 , wherein deploying the stent within the patient's iliac vein comprises either releasing a self-expanding stent or balloon expanding a balloon expandable stent.