Seshadri Raju1, Sam Owen, Peter Neglen. 1. University of Mississippi Medical Center, 1020 River Oaks Dr., Suite #420, Jackson, MS 39208, USA. rajumd@earthlink.net
Abstract
PURPOSE: The purpose of this study was the presentation of the results of iliac venous stent placement in the management of chronic venous insufficiency (CVI). METHODS: Balloon dilation and stent placement for the relief of iliac vein stenoses was performed in 304 limbs with symptomatic CVI. Sixty-one limbs had concomitant saphenous vein ablation. The median age was 52 years (range, 14 to 83 years). The ratio of postthrombotic to nonthrombotic CVI was 1 to 0.9. The CEAP classification clinical scores were: C(2), 24; C(3), 158; C(4), 60; C(5), 13; and C(6), 49. Associated reflux was present in 57% of the limbs. The procedure was performed on an outpatient basis. Intravascular ultrasound scanning was routinely performed because transfemoral venography had poor sensitivity for the detection of iliac vein stenosis. RESULTS: The actuarial primary and secondary stent patency rates at 24 months were 71% and 90%, respectively. The median degree of swelling (graded 0 to 3, for none, pitting, ankle edema, to gross leg edema) declined from grade 2 to grade 1 after surgery (P <.001). The limbs without any swelling increased from 12% before stenting to 47% after stenting (P <.01). The pain level recorded on a visual analogue scale from 0 to 10 declined from a median level of 4 to 0 after stent placement (P <.001). The limbs that were completely free of pain increased from 17% before stenting to 71% after stent placement (P <.001). Stasis dermatitis/ulceration was present in 69 limbs. The improvement in swelling and pain was similar in ulcerated and nonulcerated limbs. The cumulative recurrence-free ulcer healing rate was 62% at 24 months. The rate of ulcer healing was similar whether or not concomitant saphenous ablation was performed. Quality of life has significantly improved. CONCLUSION: The correction of iliac vein outflow obstruction with the placement of stents results in the significant relief of major symptoms of CVI. The procedure is minimally invasive, can be performed on an outpatient basis, has minimal complications with a high patency rate, and does not preclude subsequent open surgery for the correction of restenosis or the associated reflux. If these preliminary results are sustained for a long-term period, stent placement for the correction of iliac vein stenoses may represent a useful advance in the management of CVI.
PURPOSE: The purpose of this study was the presentation of the results of iliac venous stent placement in the management of chronic venous insufficiency (CVI). METHODS: Balloon dilation and stent placement for the relief of iliac vein stenoses was performed in 304 limbs with symptomatic CVI. Sixty-one limbs had concomitant saphenous vein ablation. The median age was 52 years (range, 14 to 83 years). The ratio of postthrombotic to nonthrombotic CVI was 1 to 0.9. The CEAP classification clinical scores were: C(2), 24; C(3), 158; C(4), 60; C(5), 13; and C(6), 49. Associated reflux was present in 57% of the limbs. The procedure was performed on an outpatient basis. Intravascular ultrasound scanning was routinely performed because transfemoral venography had poor sensitivity for the detection of iliac vein stenosis. RESULTS: The actuarial primary and secondary stent patency rates at 24 months were 71% and 90%, respectively. The median degree of swelling (graded 0 to 3, for none, pitting, ankle edema, to gross leg edema) declined from grade 2 to grade 1 after surgery (P <.001). The limbs without any swelling increased from 12% before stenting to 47% after stenting (P <.01). The pain level recorded on a visual analogue scale from 0 to 10 declined from a median level of 4 to 0 after stent placement (P <.001). The limbs that were completely free of pain increased from 17% before stenting to 71% after stent placement (P <.001). Stasis dermatitis/ulceration was present in 69 limbs. The improvement in swelling and pain was similar in ulcerated and nonulcerated limbs. The cumulative recurrence-free ulcer healing rate was 62% at 24 months. The rate of ulcer healing was similar whether or not concomitant saphenous ablation was performed. Quality of life has significantly improved. CONCLUSION: The correction of iliac vein outflow obstruction with the placement of stents results in the significant relief of major symptoms of CVI. The procedure is minimally invasive, can be performed on an outpatient basis, has minimal complications with a high patency rate, and does not preclude subsequent open surgery for the correction of restenosis or the associated reflux. If these preliminary results are sustained for a long-term period, stent placement for the correction of iliac vein stenoses may represent a useful advance in the management of CVI.
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