Iliac Venous Stenting for Outflow Obstruction Does Not Significantly Change the Quality of Life of Patients With Severe Chronic Venous Insufficiency

Abstract

In patients with either healed (C5) or active (C6) venous ulcers, percutaneous iliac venous stenting for intravascular ultrasound-confirmed stenosis did not have a positive impact on quality of life (QoL). In a single-center study, 172 venous ulcer patients underwent iliocaval venography and intravascular ultrasound, with 109 patients having iliac vein stent placement for >50% stenosis between the years of 2006 and 2012. The remainder were treated medically. Less than half (47%) completed a QoL survey. Moderate persistent pain and postprocedure discomfort were reported in 43% of the stented and 58% of the nonstented patients. All other QoL criteria, including physical, psychological, and social activities, were similar between the cohorts. Venous ulcerations lead to significant morbidity with negative impacts on a patient's ability to engage in activities of daily living, to maintain an active lifestyle including social relationships, and to work. There have been many single-center and multicenter studies demonstrating improvements in QoL after stenting for iliac venous outflow obstruction, including several from high-volumes centers (see any study by Néglen and Raju). It behooves the treating physician to recommend interventions that are going to make an impact, heal the ulcer, and improve the patient's life. The Joint Society for Vascular Surgery and American Venous Forum Clinical Practice Guidelines (J Vasc Surg 2014;60:3S-59S) recommendation 6.14 states that “we recommend venous angioplasty and stent recanalization in addition to standard compression therapy to aid in venous ulcer healing and to prevent recurrence. [Grade - 1; Level of Evidence - C]” This study was a retrospective review with no QoL survey given as a baseline before intervention and no correlation with low QoL scores and lack of healing, stent thrombosis, or the impact of adjunctive venous procedures such as superficial venous ablation or phlebectomies. I also find this study interesting as the footnote states that the data were presented “in part” in 2014, but the manuscript was not submitted and published until 2019.