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Published on: November 19, 2019
The effect of deep venous stenting on healing of lower limb venous ulcers
1Narayana Institute of Vascular Sciences, Narayana Hrudayalaya, Bommasandra Industrial Estate, Hosur Road, Bangalore 560100, India.
Insights
Endovascular stenting of deep veins effectively treats recalcitrant venous ulcers (C6 disease). This intervention shows high patency rates and promotes significant ulcer healing, offering a valuable treatment option.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Dermatology
Background:
- Venous ulcers (C6 disease) are challenging to treat, often failing conservative measures.
- Deep venous system interventions are considered when superficial treatments are inadequate.
Purpose of the Study:
- To evaluate the outcomes of endovascular interventions on deep veins in patients with venous ulcers.
- To assess the efficacy of deep vein stenting in promoting ulcer healing.
Main Methods:
- Retrospective case series of 38 patients (44 limbs) with venous ulcers undergoing deep vein stenting.
- Inclusion criteria: active venous ulceration, C6 disease, failure of compression or superficial vein treatment.
- Diagnostic imaging included CT venogram or ascending venogram; Nitinol stents were used.
Main Results:
- Successful stenting in 44 limbs, with lesions being post-thrombotic (31 limbs) or non-thrombotic iliac vein (13 limbs).
- High primary (94%) and assisted primary (97%) patency rates at 15 months median follow-up.
- Sustained ulcer healing in 60% of limbs; 20% showed size reduction. Recurrence in 13% healed with further intervention.
Conclusions:
- Endovascular deep vein stenting is an effective adjunct for healing recalcitrant venous ulcers.
- The procedure demonstrates favorable patency and ulcer healing rates.
- This approach offers a viable solution for complex venous ulcer cases.
Objective:
To report the outcomes of endovascular interventions on deep veins in patients with venous ulcers (C6).
Methods:
This was a retrospective review of a case series. All patients with active venous ulceration who underwent endovascular interventions to the deep venous system from February 2011 to June 2013 were included. Patients with C6 disease who failed a trial of adequate compression therapy or superficial vein interventions were considered for evaluation of the deep veins. Patients with deep vein reflux or without significant venous reflux or with a previous history of deep vein thrombosis underwent computed tomographic venogram or ascending venogram. In the absence of intravenous ultrasound trial ballooning to look for a "waist" to identify subtle lesions was used. Lesions were stented with long Nitinol stents.
Results:
Thirty-eight patients underwent deep vein stenting of 44 limbs with venous ulcers. The lesions were considered to be post-thrombotic in 31 limbs and non-thrombotic iliac vein lesions in 13 limbs. A mean of 1.8 stents were used per patient. There were no significant complications associated with the interventions. At a median follow-up of 15 months, the primary and assisted primary patency rates were 94% and 97%, respectively. Sustained ulcer healing was achieved in 60% of limbs. A further 20% of ulcers had reduced in size. Recurrent ulcers developed in 13% of limbs, and half of these healed with interventions for newly developed incompetence in superficial veins.
Conclusion:
Endovascular interventions to the deep veins appear to be an effective adjunct in achieving the healing of recalcitrant ulcers.
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