ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 121-126

Venous angioplasty with stenting for obstructive iliac vein lesions: A case series


Department of Vascular and Endovascular Sciences, Tamilnadu Government Multi Super Speciality Hospital, Madras Medical College, Tamilnadu Dr. M.G.R Medical University, Chennai, Tamilnadu, India

Correspondence Address:
Dr. S Sasikumar
Department of Vascular and Endovascular Sciences, Tamilnadu Government Multi Super Speciality Hospital, Madras Medical College, Tamilnadu Dr. M.G.R Medical University, Chennai, Tamilnadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_70_18

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Background: Deep-vein reflux has been a major cause for chronic venous insufficiency (CVI). Secondary reflux due to obstructive lesions has been treated with conservative methods. The advent of dedicated venous stent and intravascular ultrasound has renewed interest in the correction of obstructive component in CVI pathophysiology. We have followed a protocol-based approach for identifying the patients who would probably be benefitted with iliac vein stenting. Materials and Methods: Of the 156 patients who have presented to our institution over a 3-year period (2015–2018) with chronic venous insufficiency, based on the inclusion criteria, 31 patients were included with a probable diagnosis of deep-vein reflux due to obstructive iliac vein lesion. All these patients were subjected to duplex study initially and all had deep-vein reflux. Twenty-three patients had presented with superficial vein reflux. Magnetic resonance (MR) venogram was performed in all patients prior to proceeding with digital subtraction venography. Iliac vein stenting was performed in seven patients using wall stent. All patients had lesion on the left side with lesion ranging from 4 to 12 cm. Results: Seven patients who had iliac stenting had significant improvement in symptoms. Three patients had superficial venous ablative procedure done after 3 months combined with foam sclerotherapy. There were no procedure-related complications. Six-month follow-up study revealed one recurrent ulceration with bleeding superficial varices. Stent patency at 1-month follow-up was 100%. Symptomatic relief was achieved in all patients. Conclusion: Iliac vein stenting is effective in controlling CVI symptoms in selected patients. Those patients with potentially correctable lesions were identified with the application of duplex criteria for initial screening. Clinical examination and duplex criteria had equivalent predictive value compared to MR study. Symptom relief was achieved in all patients after iliac stenting. Those presenting with recurrence had adjunctive procedures with optimal results.


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