The effect of deep venous stenting on healing of lower limb venous ulcers

Abstract

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.

Keywords: Deep veins; Iliocaval obstruction; May–Thuner syndrome; NIVL; Post-thrombotic; Venous stenting; Venous ulcer.

Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.