Iliac Vein Angioplasty Augments Venous Ulcer Healing in Patients who have Standard Compression Therapy and Perforator Closure

Treatment of venous ulcers is demanding for patients as well as clinicians, and treatment of underlying venous hypertension is the cornerstone of therapy. We propose that iliac vein angioplasty and stenting (IVAS) augment healing of venous ulcers in selected patients. We conducted a retrospective review of all prospectively collected data from patients with CEAP 6 venous disease. Patient demographics, comorbidities, venous reflux studies, and ulcer description were analyzed. Iliac vein stenosis was defined as ≥50% stenosis on intravascular ultrasound. All patients had great saphenous vein ablation, in addition to conservative treatment, including Unna boot compression, and perforator closure using ablation therapy. Seventeen patients with CEAP 6 venous disease and ulcers greater than 1.5 cm in diameter were included. The average age was 63 ± 10 years of age, and the majority were female (70.6%) with common comorbidities such as hyperlipidemia (47.1%), hypertension (35.3%) and diabetes (23.5%). All patients had arterial duplex evaluations to rule out associated peripheral vascular disease. Twenty-four ulcers with an average diameter of 3.1 ± 0.9 cm and depth 2.2 ± 0.5 cm were treated. Perforator venous reflux was 3.6 ± 0.8 seconds with diameter estimated at 3.7 ± 2 mm performed in an accredited vascular laboratory. The majority (n = 15; 62.5%) of the perforator veins were located at the base of the ulcer, whereas the remainder (n = 9; 32.5%) were within 2 cm from the base. Seven (29.2%) of the 24 ulcers did not respond to the conventional therapy; all were found to have significant iliac vein stenosis and were treated with IVAS. Ulcer healing time was shorter in IVAS group (3.9 ± 1.5 weeks) than those patients receiving only perforator and Unna boot treatment (7.9 ± 9.2 weeks), although this difference was not statistically significant (P = .223), which was directly attributed to sample size. Two patients, one in each group, experienced ulcer recurrence (P = .507). The early results from this study suggest that venous ulcer healing can be augmented with iliac vein angioplasty/stenting. The majority of underlying perforators were found under or within 2 cm from the venous ulcer. However, our early results should be viewed with caution because of the small sample size. Further studies are needed to define the exact role of iliac vein angioplasty/stenting in patients with venous ulcers.