Venous Stenting for Lower Extremity Stasis Symptoms

Introduction: In a small subset of patients presenting with severe venous stasis disease, we have been unable to identify the sources of reflux with standard duplex imaging of the superficial, deep, and perforating veins. Recently, we have been examining the iliac veins with intravascular ultrasound (IVUS) imaging and venography to identify stenotic lesions and reviewed our findings with this technique. Methods: The study included 54 patients with chronic venous stasis symptoms not responding to conventional methods of treatment, including leg elevation, compression stockings, Unna boots, and radiofrequency ablation or stripping of varicose veins, perforators, or great saphenous vein. All patients underwent iliac-femoral venography with assessment for stenosis. Of these, 24 (44.4%) had no detectable stenotic lesions and had no further intervention, and 30 (55.6%) had stenotic lesions and underwent vein stenting. The stents spanned across the inguinal ligament in all but three (90%). Results: The venography-only group included 24 patients with an average follow-up of 4.5 months (range, 1 week-8 months). Eleven (45.8%) had a CEAP of 6. After 4 months, ulcers had healed in only one patient (9.1%). The vein stenting group included 30 patients with an average follow-up of 3.4 months (range, 1 week-10 months). Open ulcers were present in 22 (73.3%), and in 11 (50%), the ulcers healed in an average of 3.25 months (range, 1 week-8 months; P = .02). Complications occurred in three patients (5.5%), including stent thrombosis in two (one with a documented hypercoagulable state, one with a suspected hypercoagulable state). Both were reopened and restented. A superficial femoral artery pseudoaneurysm in one patient was repaired with a stent graft. All patients not needing postoperative anticoagulation underwent stenting as outpatients. Conclusion: Many patients with lower extremity venous stasis symptoms have a component of iliac vein stenosis, and iliac vein stenting may especially help patients with open ulcers. In contrast to pre-existing series, only 50% of the patients were able to have lesions identified to be stented. The procedure is relatively simple and safe, and can be performed on an ambulatory basis.