Effect of iliofemoral-caval venous intervention on lower extremity compartment pressure in patients with chronic venous insufficiency

Abstract

BackgroundChronic compartment syndrome (CCS) secondary to venous hypertension from chronic venous insufficiency is an uncommonly described entity. The measurement of high resting compartment pressure is helpful in establishing the diagnosis of CCS. The effect of deep venous intervention on compartment pressures in patients with chronic venous insufficiency is not well described. This study evaluated a subset of patients with signs and symptoms of venous disease in whom intervention (hyperdilation or new endovenous stent placement) was performed on the iliofemoral-caval venous system. The effect of the specific intervention was objectively measured by documenting preoperative and postoperative compartment pressures in the posterior superficial compartment of the calf at rest in the supine position. MethodsFrom January 2018 to January 2019, there were 80 limbs that underwent either hyperdilation (n = 34) or new endovenous stent placement (n = 46). All patients had measurement of compartment pressures before and after intervention with a simple needle manometer system. Values of 15 mm Hg or higher were considered indicative of CCS in the appropriate clinical context. Clinical parameters such as pain, swelling, and Venous Clinical Severity Score were measured preoperatively and postoperatively. ResultsVenous intervention in the form of hyperdilation or endovenous stent placement was associated with reduction in compartment pressure of the extremity undergoing the intervention. In the new stent subset, the compartment pressure was reduced from 17.4 (±4.9) mm Hg to 12.6 (±3.7) mm Hg (P < .0001). In the hyperdilation subset, the compartment pressure was reduced from 14.9 (±4.1) mm Hg to 10.3 (±2.7) mm Hg (P < .0001). There was also a significant improvement in pain, swelling, and Venous Clinical Severity Score after intervention. In patients undergoing hyperdilation, there was a significant improvement in the ejection fraction of the calf pump after intervention from 54.8% (±23.1%) to 52.1% (±18.7%; P = .009). ConclusionsDeep venous intervention in the form of hyperdilation or endovenous stent placement was associated with symptomatic improvement and reduction of compartment pressure of the extremity undergoing intervention.