Unexpected major role for venous stenting in deep reflux disease

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Presentation transcript:

Unexpected major role for venous stenting in deep reflux disease Seshadri Raju, MD, Rikki Darcey, BS, Peter Neglén, MD, PhD Journal of Vascular Surgery Volume 51, Issue 2, Pages 401-408 (February 2010) DOI: 10.1016/j.jvs.2009.08.032 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Intravascular ultrasound (IVUS) scan appearance of a post-thrombotic stenosis. Lumen compromise and wall thickness are evident. The electronic scale (graticule shown) and planimetry capabilities of IVUS instrumentation allow accurate assessment of diffuse and focal stenoses. Journal of Vascular Surgery 2010 51, 401-408DOI: (10.1016/j.jvs.2009.08.032) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Transfemoral antegrade venogram in a limb with a primary obstructive lesion. A translucent slight broadening of the iliac-caval junction can be noted on close inspection, but the venogram appears otherwise unremarkable (left). An obstructive lesion was obvious on intravascular ultrasound (IVUS) examination. Subsequent balloon dilatation prior to stenting shows tight focal “waisting” (right). Journal of Vascular Surgery 2010 51, 401-408DOI: (10.1016/j.jvs.2009.08.032) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Diffuse post-thrombotic iliac vein stenoses occur from a constricting perivenous fibrotic sheath that prevents collateral formation as originally described by Rokitanski. Such lesions are easily overlooked on venography. Close inspection in this instance shows an iliac vein that is substantially more narrowed as compared to the femoral vein as highlighted by arrows (left). A uniform diameter of the vein is achieved after iliac vein stent placement (right). Journal of Vascular Surgery 2010 51, 401-408DOI: (10.1016/j.jvs.2009.08.032) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Cumulative secondary stent patency in 395 limbs with combined obstruction and reflux. Separate cumulative curves are shown for primary, post-thrombotic, and combined etiologies (SEM <10%). Journal of Vascular Surgery 2010 51, 401-408DOI: (10.1016/j.jvs.2009.08.032) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 Cumulative rate of pain relief after stent placement in 323 patients complaining of pain prior to treatment. Curves representing limbs with complete relief (no residual pain) and limbs with substantial improvement are given (SEM <10%). VAS, Visual analog scale. Journal of Vascular Surgery 2010 51, 401-408DOI: (10.1016/j.jvs.2009.08.032) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 6 Cumulative rate of swelling relief after stent placement in 367 patients complaining of swelling prior to treatment. Curves representing limbs with complete relief (no residual swelling) and substantial improvement are given (SEM <10%). Journal of Vascular Surgery 2010 51, 401-408DOI: (10.1016/j.jvs.2009.08.032) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 7 Cumulative rates of ulcer-free C5 limbs (ie, limbs with healed ulcers at the time of stenting, n = 32), dermatitis-free C4a limbs (limbs with active dermatitis at the time of stenting, n = 57), and healed ulcers in C6 limbs (limbs with active ulcer at the time of stenting, n = 114; SEM <10%). A grace period of 4 months for initial healing of limbs with active leg ulcer was allowed at which time limbs with unhealed ulcers were censored. Similarly, a 5-month grace period was given for dermatitis to heal before the limbs with on-going dermatitis were censored. This explains the drop of the curves at 4 and 5 months (33% and 8%, respectively). Journal of Vascular Surgery 2010 51, 401-408DOI: (10.1016/j.jvs.2009.08.032) Copyright © 2010 Society for Vascular Surgery Terms and Conditions