The aim of the observational study, Rosales said, was to determine the mid-term patency and the clinical outcome after stenting chronic caval and iliofemoral venous segments. Between 2000 and 2009, 2,400 patients with severe chronic venous insufficiency were initially evaluated with colour duplex ultrasound and ambulatory venous pressure measurement.
Fifty-nine patients with severe symptoms including venous claudication, oedema, pain and leg ulcer suggesting venous outflow impairment were further investigated with ascending venography, venous occlusion plethysmography, venous pressure gradient and computed tomographic venography or transfemoral/popliteal venography.
The severity of the symptoms rendered patients incapable of functioning at work and/or in other physical activities, representing a clear indication to attempt endovascular treatment. Twenty five patients were found unavailable to endovascular treatment due to the extension of the post-thrombotic occlusion to the popliteal level that precluded adequate inflow possibilities.
The other 34 patients showed to have chronic venous occlusions after deep vein thrombosis with open popliteal and caudal superficial femoral veins, and were chosen for treatment. This group was then categorised according to the CEAP (clinical-etiological-anatomical-pathophysiological) classification for chronic venous insufficiency.
The severity of symptoms was quantified using the venous clinical severity score. Median age was 41 years (15–63) and 19 were females. The time elapsed after the last deep vein thrombosis episode varied with a median of 108 months (9–420).
Seventeen patients (50%) had a thrombophilia (activated protein C resistance, protein C or S deficiency and homocysteinemi). The major symptoms were: venous claudication in 27 patients, oedema in 24, pain in 21 and leg ulcer in seven. All patients were treated with stenting; self-expanding stents were deployed in 22 iliofemoral, nine iliac and one caval-iliac femoral. Twenty one procedures required stenting across the inguinal ligament.
Primary recanalisation was accomplished in 32/34 (94%). The median follow-up was 33 months (1–96) with clinical examination, colour duplex ultrasound and venous occlusion plethysmography. Two year primary patency was 14/21 (67%) primary-assisted patency 16/21 (76%) and secondary patency was 19/21 (90%). Venous claudication and oedema resolved in those successfully recanalised and four of seven ulcers healed.
In conclusion, Rosales said, “Chronic post-thrombotic vena cava and iliofemoral venous occlusions causing venous claudication and leg ulcer can be treated endovascularly. It has good clinical outcomes, mid-term patency is good and stenting crossing the groin is necessary to secure inflow.” Surveillance, catheter-directed thrombolysis, re-stenting and surgery when necessary should be implemented to accomplish the best secondary patency possible, he said.
