Successful iliac vein and inferior vena cava stenting ameliorates venous claudication and improves venous outflow, calf muscle pump function, and clinical status in postthrombotic syndrome

Abstract

Conclusion: Successful stenting of iliac-femoral (I-F) veins or the inferior vena cava (IVC), or both, improves venous claudication and some measures of venous function. Summary: The purpose of the study was to determine effects of successful stenting of patients with chronic venous disease. Consecutive patients were analyzed. The patients had previously failed conservative treatment with compression or wound care for at least 12 months. Patients had moderate-to-advanced venous disease (CEAP classifications 3 to 6), with or without venous claudication. Venous claudication was determined by the judgement of at least three independent examiners. Plethysmography was used to determine venous filling index (VFI) as a measure of venous reflux, ejection fraction (EF) as a measure of calf muscle pump function, and residual volume fraction (RVF) as a measure of ambulatory venous hypertension. Outflow fractions at 1 and 4 seconds were also determined. The study assessed 23 limbs in 16 patients. Control limbs (n = 9) were those limbs without infrainguinal clots on duplex scanning and without prior I-F thrombosis. Patients were excluded if they had malignancy, stent occlusion or stenosis, peripheral arterial disease, symptomatic cardiac disease, or unrelated causes of walking impairment. Venous outflow and calf muscle function was reduced and RVF was increased in the limbs with I-F ± IVC thrombosis compared with the control group (P < .05 for all comparisons). At 8.4 months, successful I-F ± IVC stenting improved venous outflow, calf muscle pump function, and RVF (P < .001 for all comparisons). CEAP class also improved after intervention (P < .05). Patients with successful I-F ± IVC stenting did have worsening of VFI by 24% (P = .002). At 8.4 months, venous outflow, calf muscle pump function, and RVF in the control limbs did not differ from the stented limbs. Venous reflux as measured by VFI was worse in the stented limbs (P < .0025). Before treatment, 15 of 23 limbs (10 of 16 patients) had incapacitating venous claudication. After successful stenting, venous claudication was eliminated in all the affected limbs (P < .001). Comment: The study suggests that patients with venous claudication due to an I-F venous obstruction may be improved by stenting. This study, however, has several weaknesses: it is essentially a retrospective analysis, the follow-up is short, there was no objective measurement of venous claudication, and only successfully treated patients were analyzed, making it impossible to determine the true efficacy of I-F ± IVC stenting in patients with chronic venous disease.