Iliac vein stenting in postmenopausal leg swelling

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Presentation transcript:

Iliac vein stenting in postmenopausal leg swelling Seshadri Raju, MD, Matthew Oglesbee, BS, Peter Neglén, MD, PhD Journal of Vascular Surgery Volume 53, Issue 1, Pages 123-130 (January 2011) DOI: 10.1016/j.jvs.2010.07.068 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 Painful foot swelling with inability to wear proper footwear. Journal of Vascular Surgery 2011 53, 123-130DOI: (10.1016/j.jvs.2010.07.068) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 Limb swelling in a postmenopausal woman retarding mobility; note compression marks. Journal of Vascular Surgery 2011 53, 123-130DOI: (10.1016/j.jvs.2010.07.068) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 Nonthrombotic iliac vein lesion (NIVL) in a patient with postmenopausal leg swelling. Both proximal and distal lesions are present (left and middle). The venogram was unremarkable (right). Diagnostic sensitivity of venography in the diagnosis of iliac vein lesions is poor (see text). Journal of Vascular Surgery 2011 53, 123-130DOI: (10.1016/j.jvs.2010.07.068) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 Types of postthrombotic iliac vein lesions that can remain silent for years before swelling is precipitated by a secondary insult. Focal stenosis (left); diffuse iliac stenosis (center); note size discrepancy between the femoral and iliac veins (arrows) and the absence of collaterals; chronic total occlusion (right). Journal of Vascular Surgery 2011 53, 123-130DOI: (10.1016/j.jvs.2010.07.068) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 5 Cumulative stent patency (secondary) curves in postmenopausal leg swelling. Separate curves are shown for primary (NIVL), postthrombotic etiologies, and overall. Journal of Vascular Surgery 2011 53, 123-130DOI: (10.1016/j.jvs.2010.07.068) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 6 Cumulative relief of pain after iliac vein stent placement in patients with postmenopausal leg swelling. Separate curves are shown for significant (≥ 3 VAS) and total relief of pain. Journal of Vascular Surgery 2011 53, 123-130DOI: (10.1016/j.jvs.2010.07.068) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 7 Cumulative relief of swelling after iliac vein stent placement in postmenopausal women. The upper curve shows swelling improvement as reported by the patient (subjective). The bottom two curves represent objective assessment by examination: significant (≥1 grade) improvement and for complete relief of swelling. Journal of Vascular Surgery 2011 53, 123-130DOI: (10.1016/j.jvs.2010.07.068) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 8 Trauma to the limb (left), infection (cellulitis, center), or orthopedic joint replacement (bilateral knee replacement, right) can precipitate leg swelling in the context of a preexisting permissive iliac vein lesion (see text). Postmenopausal women are subject to numerous other secondary factors including onset of reflux that may aggravate to render a previously silent iliac vein obstructive lesion symptomatic with onset of leg swelling. Journal of Vascular Surgery 2011 53, 123-130DOI: (10.1016/j.jvs.2010.07.068) Copyright © 2011 Society for Vascular Surgery Terms and Conditions