Unexpected major role for venous stenting in deep reflux disease

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Phlebology

Background:

• Chronic venous insufficiency (CVI) treatment traditionally focuses on reflux, with deep reflux posing significant challenges.
• Minimally invasive techniques and intravascular ultrasound (IVUS) have advanced CVI management, highlighting the role of obstructive venous disease.
• Iliac vein obstruction and deep venous reflux are key pathophysiological components in advanced CVI.

Purpose of the Study:

• To evaluate clinical and stent-related outcomes of iliac venous stenting as a standalone treatment for CVI.
• To assess the efficacy of iliac vein stenting in limbs with both obstruction and deep venous reflux.
• To determine the role of IVUS-guided stenting in managing complex CVI.

Main Methods:

• A cohort of 528 limbs (504 patients) underwent IVUS-guided iliac vein stenting over 11 years.
• Patients presented with nonthrombotic, post-thrombotic, or combined iliac vein obstruction, with all having deep venous reflux.
• CEAP clinical severity ranged from C3 to C6, with a significant proportion experiencing severe or axial reflux.

Main Results:

• No mortality was observed; morbidity was minor.
• Cumulative secondary stent patency reached 88% at 5 years, with no occlusions in nonthrombotic limbs.
• Significant improvements were noted in ulcer healing (54%), ulcer recurrence freedom (88%), dermatitis freedom (81%), pain relief (78%), and swelling reduction (55%), with enhanced quality of life.

Conclusions:

• Iliac venous stenting alone provides substantial symptom control for the majority of CVI patients with combined obstruction and deep reflux.
• This approach offers partial correction of CVI pathophysiology, leading to significant symptom relief in complex cases.
• Percutaneous stenting, combined with other minimally invasive techniques, reduces the need for open surgical correction in advanced CVI.