Validation of venous duplex ultrasound imaging in determining iliac vein stenosis after standard treatment of active chronic venous ulcers.

Abstract

Chronic venous ulcer (CVU) is a potentially debilitating condition that remains the most common etiology for leg ulcers. The condition has significant associated costs and effect on patient quality of life. That truncal reflux can be worsened by iliac vein occlusive disease is well known. However, there has not been systematic investigation of venous duplex ultrasound (VDUS) criteria to correlate common femoral vein (CFV) reflux with iliac vein stenosis. We sought to correlate VDUS criteria for predicting iliac vein stenosis and to investigate venous outflow factors associated with CVU recurrence. We conducted a systematic retrospective review of a consecutive series of 36 patients who received standard therapies, including compression therapy along with ablation of incompetent great saphenous veins for treating CVU, but in whom the treatment failed. Elevated CVF reflux was considered as reflux duration (RD) measured by VDUS to last >1second. A receiver operator characteristic curve analysis wasperformed to determine the optimal CFV threshold value to predict 50% iliac vein stenosis measured by intravascular ultrasound. The 36 patients presented with 54 CVUs on 38 limbs. The median (25th-75th quartiles) age was 61.2 (57.6-68.8) years, body mass index was 36.8 (25.2-52.3) kg/m(2), CFV RD was 2.7 (1.6-3.5) seconds, ulcer diameter was 4.2 (3.0-4.0) cm, and ulcer depth was 2.5 (2.0-3.0) mm. The optimal cutoff RD value was >2.5seconds by receiver operator characteristic curve analysis, with an area under the curve of 0.77 (P= .001). CVUs associated with an RD >2.5seconds had significantly more iliac vein stenosis >50% by intravascular ultrasound (24 of 30; 80%) than those with an RD<2.5seconds (6 of 24; 25%; P< .001). Likewise, >50% stenosis for those above and below an RD >1second was 61.4% vs 30%, respectively (P= .089). Significantly less recurrence of CVU was found for patients taking pentoxifylline (43.6% vs 80.0%; P= .031) and those with stents placed (40.0% vs 70.8%; P= .031). A nonsignificant trend was found for iliac vein interrogation (44.4% vs 72.2%; P=.082). This study highlights the utility of VDUS in diagnosing iliac vein stenosis with 2.5seconds to predict ≥50% iliac vein stenosis. Stent placement and pentoxifylline were associated with ulcer healing and reduced risk of venous ulcer recurrence.