Iliac-caval stenting in the obese

Area of Science:

• Vascular Surgery
• Obesity Medicine
• Venous Disease Management

Background:

• Chronic venous insufficiency (CVI) is increasingly prevalent in obese individuals, often presenting with severe symptoms.
• Traditional conservative treatments for CVI are frequently ineffective in obese patients.
• Iliac-caval venous stenting is a potential treatment, but concerns exist regarding its application in obesity.

Purpose of the Study:

• To evaluate the safety and efficacy of iliac-caval venous stenting in obese patients with severe CVI.
• To compare outcomes in obese patients with a large cohort of non-obese patients undergoing the same procedure.
• To investigate the underlying mechanisms of venous obstruction in obese CVI patients.

Main Methods:

• Retrospective analysis of 101 limbs in 87 obese patients undergoing iliac-caval venous stenting.
• Comparison with 1513 non-obese limbs stented over an 11-year period.
• Assessment of clinical features, venous testing, intravascular ultrasound (IVUS), and long-term outcomes.

Main Results:

• Obese patients had twice the incidence of bilateral CVI manifestations compared to non-obese.
• IVUS revealed similar obstructive lesions in 89% of obese limbs; 11% attributed to obesity-related compression.
• Stenting demonstrated low morbidity (3% DVT), high patency (86% at 5 years), and significant symptom improvement (pain, swelling, ulcer-free rates).

Conclusions:

• Venous obstruction mechanisms in obese CVI are similar to non-obese, with a minor contribution from abdominal compression.
• Iliac-caval venous stenting is a safe and effective option for obese patients with severe CVI.
• The procedure provides substantial and lasting clinical improvement for this patient population.