Iliofemoral Thrombosis Research Articles

Deep vein thrombosis associated with protein C and protein S deficiency: An unusual cause of acute abdomen

Deep venous thrombosis is an extremely rare cause of acute abdomen and is often difficult to diagnose. Protein C and protein S deficiencies are rare genetic abnormalities that predispose the patient to thrombophilia and lead to thrombosis. We report the case of a previously healthy 7-year-old boy with iliofemoral thrombosis due to protein C and protein S deficiencies mimicking acute abdomen.

Hyperkalaemia associated with hydroxyurea in a patient with polycythaemia vera

Hydroxyurea has been used for decades for the treatment of some types of malignancies [1]. It has been demonstrated to be very effective in preventing thrombosis and thus should be considered as first-line therapy in high-risk patients with myeloproliferative disorders [2]. An 81-year-old woman was admitted to hospital in December 2009 because of hyperkalaemia. Her medical history included essential hypertension for the last 15 years. She had been diagnosed with polycythaemia vera in April 2007 and an initial treatment consisted of phlebotomy and low-dose acetylsalicylic acid. In May 2009 the patient had developed iliofemoral vein thrombosis as a consequence of polycythaemia vera. To prevent further thromboembolic complications, therapy with hydroxyurea had been introduced. At the time of admission, the patient's therapy included ramipril (2.5 mg), acetylsalicylic acid (100 mg) and hydroxyurea (1,000 mg) daily. Serum potassium level was 6.7 mmol/L (normal range 3.9–5.1 mmol/L). Levels of sodium, chloride, calcium, lactate dehydrogenase and creatine kinase were all within normal values. Haemoglobin concentration, haematocrit, white and red blood cells and platelet count were normal as were values for plasma aldosterone, plasma renin activity and 24-h urinary free cortisol. Arterial blood pH and bicarbonates were mildly decreased (pH 7.318, bicarbonates 18.9 mmol/L). Patient's renal function was decreased with serum creatinine of 116 μmol/L and 24-h creatinine clearance of 41.7 ml/min. Electrocardiogram (ECG) showed no abnormality. Since there was no significant difference between the serum and plasma potassium levels, pseudohyperkalaemia could be excluded [3]. Because of the possibility that hyperkalaemia was caused by ramipril or acetylsalicylic acid, therapy with these drugs was discontinued. Repetitive administration of bicarbonate and insulin/glucose did not decrease the potassium level and after 7 days it remained high (5.8–6.4 mmol/L). The degree of hyperkalaemia could not have been explained by moderate renal insufficiency and the clinical investigation did not find any other possible cause. Thus, we suspected that it could have been caused by an adverse reaction to hydroxyurea. Therapy with hydroxyurea was discontinued and 2 days later the potassium level decreased to 5.0 mmol/L. Since hyperkalaemia was not listed as an adverse reaction in the Summary of Product Characteristics and no similar cases have been reported in the literature, we were not convinced that it was really caused by hydroxyurea. Hyperkalaemia was asymptomatic and caused no ECG changes in the presented case; thus, we believed that rechallenge would not endanger the patient. After Ethics Review Board approval she was re-administered 500 mg of hydroxyurea daily. After the second dose, the serum potassiS. Marusic (*) :N. Gojo-Tomic Department of Clinical Pharmacology, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia e-mail: srmarusic@inet.hr

Iliofemoral venous thrombosis from external compression by a vesical diverticulum

Twenty six percent to 47% of venous thromboembolisms (VTE) are classified as idiopathic. Deep venous thrombosis (DVT) due to external compression of the venous system by various lesions has been reported in the literature. Identification of such lesions may obviate the need for prolonged anticoagulation and prevent recurrence. An important step in the evaluation of cases with iliofemoral thrombosis is to obtain computed tomography (CT) of the abdomen and pelvis to identify any potential pathology. We report a case of acute unilateral iliofemoral DVT caused by external compression from a vesical diverticulum. The CT scan played a crucial role in the diagnosis and guided management.

May-Thurner Syndrome Complicated by Acute Iliofemoral Vein Thrombosis: Helical CT Venography for Evaluation of Long-Term Stent Patency and Changes in the Iliac Vein

The purpose of this study was to use CT venography to evaluate long-term patency and changes in the iliac veins after stent placement for acute iliofemoral vein thrombosis due to May-Thurner syndrome. From December 1999 to July 2007, 30 patients (22 women, eight men; age range, 30-78 years; mean, 56.7 years) with acute iliofemoral vein thrombosis due to May-Thurner syndrome diagnosed with CT venography were treated with catheter-directed thrombolysis and stent placement. The patients underwent follow-up CT venography at variable intervals according to clinician discretion. The primary objective was to determine the primary patency of the stented segment. The secondary objective was to investigate the potential role of CT venography by analyzing the morphologic features and interval changes in stented iliac veins. Cumulative primary and secondary stent patency rates were calculated by Kaplan-Meier estimation. Four stent occlusions and one stent collapse were found at the first follow-up CT venographic examination within 1 year (mean duration, 129.3 days) after treatment. One stent occlusion and one stent collapse were managed successfully. The primary and secondary patency rates were 83.3% and 90% 1 and 5 years after treatment. The morphologic features of the common iliac vein did not affect stent patency or expanded stent diameter. During sequential CT venographic follow-up, no new in-stent stenosis or occlusion was found. Iliac stents placed for May-Thurner syndrome with acute thrombosis had excellent long-term patency. Restenosis or occlusion occurred early, and initial luminal patency was well maintained during long-term follow-up.

Prevention and treatment of venous ulcers in primary chronic venous insufficiency

Prevention and treatment of venous ulcers in primary chronic venous insufficiency

Severe Cramping Thigh Pain

Physiatric practices, which regularly act as consultants to the emergency center, often encounter challenging pain and weakness diagnostic problems.1 Although most eventually prove to be relatively routine neuromusculoskeletal diagnoses, on occasion other organ systems may be the actual source of symptoms, including among others vascular or visceral pathology, that is, splenic ruptures, kidney, and gallbladder lithiasis. In the urgent triage-oriented environment of the emergency center, although imaging technology is now readily available, at the bedside a thorough history and physical examination still remain essential to a discriminating differential diagnosis. When pain is the pre-eminent complaint, its intensity, anatomical distribution, temporal history, and relation to activity levels are all critical factors in achieving an accurate diagnosis. A 50-yr-old man presented to an acute general hospital emergency center after a near syncopal episode. He complained of severe left groin “pressure” with pain radiation into the thigh during ambulation. The discomfort was so severe that he had a syncopal episode, lost his balance, and fell. He also complained of intermittent low-back pain. He denied joint swelling and joint erythema in either of the lower limbs and a previous history of circulatory problems. A computed tomographic scan of the abdomen and pelvis was reported to be normal. The neuromusculoskeletal examination was unremarkable as was the vascular examination of the limb. There was no evidence of an inguinal hernia. His gait pattern was initially stable; however, after walking 15–20 feet, he increasingly complained of severe groin “pressure” with pain radiation to the left medial thigh. Magnetic resonance imaging of the lumbar spine demonstrated degenerative vertebral disc disease and evidence of bilateral iliac vein distention, suggesting the presence of a thrombosis (Fig. 1). Later, duplex imaging with color and spectral Doppler confirmed the presence of extensive bilateral iliofemoral thrombosis. A subsequent computed tomographic scan of the chest revealed the presence of multiple pulmonary emboli. An inferior vena cava filter was inserted, and a thrombolysis was successfully completed.FIGURE 1: Extensive bilateral iliofemoral thrombosis in the lower limbs.In its late stages, iliofemoral venous thrombosis can readily be recognized by the clinical signs of “phlegmasia cerulea dolens.”2 This syndrome features limb pain, swelling, and cyanosis as the once local clot propagates distally throughout the deep and superficial venous “tree.” Approximately 2%–10% of these patients will progress to this critical stage requiring emergent surgery.3 Early diagnosis is essential to initiating anticoagulant therapy while the clot is confined only to the iliac and femoral veins.4 The presence of a hypercoagable state, an occult malignancy, and an obstruction to venous return will accelerate the distal clot formation and increase the risk of pulmonary emboli. Retrospectively, the pain description in this patient was that of an ischemic claudication aggravated by ambulation and relieved by sitting. However, there were no overt clinical signs of vascular compromise in the lower limbs. The neuromuscular examination was also normal, the eventual diagnosis further confounded by a remote history of low-back pain. Historically, vascular and neurogenic claudication can mimic one another. In this particular case, spinal stenosis and iliofemoral thrombosis had been considered in the differential diagnosis. Fortunately, it was initially recognized on a lumbar spinal magnetic resonance imaging to be subsequently confirmed by duplex Doppler imaging. As in many challenging diagnostic situations, astute clinicians must remember to “think outside the box” by always being open to a diagnosis not necessarily in their particular area of expertise. As this case demonstrates, an accurate history is the first step in this regard.

Early surgery for iliac-femoral post-thrombotic syndrome and related experimental study

To confirm the occurrence time of iliac-femoral post-thrombotic syndrome (IFPTS) with the experimental analysis of fibrinolytic activation and vessel wall remodeling after iliofemoral vein thrombosis (IFVT). To explore the optimal timing of surgery for IFPTS with comparative study of surgical effect after early and late treatment. IFVT was performed on 20 SD rats. The plasminogen activation [tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and vascular remodeling (positive rates of internal elastic membrane, vascular perimeter and vessel wall stiffness index) were detected by immunohistochemistry and Weigert Van Gieson staining respectively. Fifty-one IFPTS patients with Palma-Dale treatment from January 1990 to December 2005 were divided into early surgical group (1 to 2 months after IFVT) and later surgical group (> 2 months after IFVT), including 20 patients and 31 patients respectively. Treatment effects were evaluated by venous clinical severity score (VCSS). The positive rate of internal elastic membrane decreased significantly at the 4th, 8th and 12th week (P < 0.01), while the vessel wall stiffness index increased at the same time (P < 0.01). The vascular perimeter elevated obviously at 12th week (P < 0.05). Symptoms of early treatment group improved significantly after surgery (3.4 ± 0.9 vs. 5.2 ± 1.2, P < 0.05). Whereas the late treatment group had no significant changes of symptoms (6.8 ± 1.7 vs. 7.6 ± 3.0, P > 0.05). The present findings suggest that IFPTS occurs around first month after IFVT. Acceptable surgery timing for IFPTS exists at 1 to 2 months post-IFVT.

External iliac vein compression and thrombosis by a migrated acetabular screw following total hip arthroplasty.

A fifty-nine year old gentleman underwent a right total hip replacement in another hospital for protrusio osteoarthritis of the right hip. Post-operatively he developed a large right-sided ilio-femoral deep venous thrombosis. A pelvic radiograph showed that the acetabular construct had migrated medially into the pelvis with a CT scan showing compression of the external iliac vessels by one of the acetabular screws. Revision surgery was carried out in collaboration with the vascular surgeons. This case report highlights the importance of pre-operative planning to avoid medial wall perforation in patients with protrusio osteoarthritis. It also illustrates an unusual complication of compression of the external iliac vessels causing massive ilio-femoral thrombosis.The management of this potentially limb threatening complication is described in this case report.

Endovascular Treatment of Complications of Femoral Arterial Access

Endovascular repair of femoral arterial access complications is nowadays the treatment of choice in a group of patients who cannot tolerate vascular reconstruction and bleeding due to advanced cardiovascular disease. Endovascular procedures can be performed under local anesthesia, are well tolerated by the patient, and are associated with a short hospitalization time. Ninitinol stent technology allows for safe stent and stent-graft extension at the common femoral artery (CFA) level, due to increased resistance to external compression and bending stress. Active pelvic bleeding can be insidious, and prompt placement of a stent-graft at the site of leakage is a lifesaving procedure. Percutaneous thrombin injection under US guidance is the treatment of choice for femoral pseudoaneurysms (PAs); this can theoretically be safer with simultaneous balloon occlusion across the entry site of a PA without a neck or with a short and wide neck. In a few cases with thrombin failure due to a large arterial defect or accompanying arteriovenous fistula (AVF), a stent-graft can be deployed. The vast majority of catheter-induced AVFs can be treated effectively with stent-graft implantation even if they are located very close to the femoral bifurcation. Obstructive dissection flaps localized in the CFA are usually treated with prolonged balloon inflation; however, in more extensive dissections involving iliac arteries, self-expanding stents should be deployed. Iliofemoral thrombosis can be treated effectively with catheter-directed thrombolysis (CDT) followed by prolonged balloon inflation or stent placement. Balloon angioplasty and CDT can occasionally be used to treat stenoses and occlusions complicating the use of percutaneous closure devices.

Use of Wall Stent to Exclude a Thrombosed Inferior Vena Cava Filter

The use of inferior vena cava (IVC) filters has increased dramatically over the last two decades. Thrombosis of the IVC is a potentially catastrophic complication of caval filter placement, and its reported incidence ranges 3.6-11.2%, depending on filter type. We present a 69-year-old female with a history of deep vein thrombosis of the right leg. Prior to a planned spinal operation, a Gunther Tulip filter was placed (Cook Medical, Bloomington, IN). Postoperatively, the patient developed bilateral iliofemoral thrombosis that extended into the IVC filter. Several weeks passed, and after unsuccessful attempts at recanalization in the community setting, the patient was referred to our group for treatment. After an unsuccessful attempt at balloon angioplasty, two 10 x 60mm Protégé GPS stents (EV3, Plymouth, MN) were deployed in the common femoral, external, and internal iliac veins bilaterally. After an unsuccessful attempt at retrieval, the Tulip filter was excluded from the IVC using a 16 x 60mm Wall Stent (Boston Scientific, Natick, MA). Unobstructed flow was now noted from the femoral system all the way through the superior vena cava. The patient experienced immediate relief of her symptoms.

Residual iliofemoral thrombosis in a 31‑year‑old woman on oral contraceptives possessing heterozygous factor V Leiden, factor XIII Val34Leu allele and α-fibrinogen Thr312Ala allele

We present the case of a 31-year-old woman on oral contraceptives with a 3-year history of iliofemoral thrombosis resistant to recanalization despite satisfactory anticoagulation therapy and absence of concomitant diseases. Thrombophilia screening revealed heterozygous factor V Leiden mutation. We also detected the presence of factor XIII (FXIII) Leu34 allele and alpha-chain fibrinogen 312Ala allele, which are known to adversely affect fibrin clot structure and lysis. It might be speculated that the presence of 3 polymorphisms in this patient could contribute to proximal thrombosis resistant to treatment. We postulate that determination of FXIII and alpha-fibrinogen polymorphisms can be useful in the evaluation of some young patients with deep vein thrombosis.

Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal

Suresh Vedantham, MD, Akhilesh K. Sista, MD, Seth J. Klein, MD, Lina Nayak, MD, Mahmood K. Razavi, MD, Sanjeeva P. Kalva, MD, Wael E. Saad, MD, Sean R. Dariushnia, MD, Drew M. Caplin, MD, Christine P. Chao, MD, Suvranu Ganguli, MD, T. Gregory Walker, MD, and Boris Nikolic, MD, MBA, for the Society of Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe Standards of Practice Committees

Acute iliofemoral deep venous thrombosis due to giant ovarian tumor: Report of a hybrid treatment

Ovarian tumors rarely cause acute iliofemoral thrombosis due to direct compression. This case represents an example of successful therapy using an interdisciplinary approach. A 37-year-old woman was admitted with a painful swelling of the left lower limb. Computed tomography revealed a giant abdominal mass originating from the left ovary producing a thrombotic occlusion of the left iliofemoral veins. Surgical treatment consisted of complete tumor removal, adnexectomy and appendectomy. During the same operation, transfemoral thrombectomy and stent implantation in the iliac vein were performed, followed by creation of an arteriovenous fistula in the left groin. Hystologic examination revealed a well-differentiated mucinous ovarian adenocarcinoma. The patient recovered well and is tumor-free 6 months after surgery. The deep venous system is still patent at follow-up. In this case, minimal surgical trauma and complete tumor as well as thrombus removal succeeded through a positive complementary interdisciplinary approach.

Incidence and Risk Factors for Bilateral Deep Venous Thrombosis of the Lower Limbs

The incidence of bilateral deep venous thrombosis in patients with single limb or bilateral symptoms was determined using duplex scan examination. In a prospective study, 157 inpatients with clinical suspicion of deep venous thrombosis underwent duplex scan evaluation of the lower extremities. Demographic characteristics, physical examination data, and risk factor information were collected. In all, 57 (36.3%) patients evaluated presented echographic evidence of acute deep venous thrombosis. Forty-six individuals presented unilateral thrombosis, and 11 patients presented bilateral disease (19.3% of all thrombosis, 7.0% of all patients). Sensitivity and specificity of clinical examination in identifying bilateral thrombosis was 27.2% and 93.3%, respectively. For the risk factors evaluated, active human immunodeficiency virus disease and iliofemoral thrombosis presented an increased risk for bilateral thrombosis (P = .045 and P = .049, respectively). The high incidence of bilateral deep venous thrombosis justifies bilateral duplex scan examination. Active human immunodeficiency virus disease and proximal thrombosis were risk factors for bilateral disease.

Endovascular Treatment of Venous Occlusive Disease

Endovascular treatment of acute and chronic iliac vein occlusions has proven to be safe and effective. Recanalization of chronic occlusions with balloon angioplasty and stenting can re-establish normal venous flow in the iliac veins and the IVC and relieve symptoms in the majority of treated patients. CDT with recanalization and stenting of underlying chronically obstructed iliofemoral segments is becoming the treatment of choice for patients with acute iliofemoral thrombosis, as anticoagulation and compression therapy alone are not satisfactory in preventing PTS. The new treatment modalities offer stimulating options for a patient group that is not adequately treated, neither by medical nor open surgical therapy. The substantial effort and additional costs of endovascular treatment appear to be justified by the encouraging mid-term results both for patients with acute and chronic occlusive iliofemoral disease. However, multi-center randomized prospective studies are required to further validate the role of these techniques.

Remote Cerebellar Hemorrhage and Iliofemoral Vein Thrombosis After Supratentorial Craniotomy

Cerebellar hemorrhage following supratentorial craniotomy is rare. Its clinical symptoms are often mild and transient. Here, we report a case of cerebellar hemorrhage associated with iliofemoral vein thrombosis as a complication of anterior temporal lobectomy and amygdalohippocampectomy for refractory medial temporal epilepsy.

Fever and haemoptysis in an injecting drug user

A 46-yr-old injecting drug user was admitted with a history of repeated haemoptysis, pleuritic chest pain and fevers. He had a neutrophilia and elevated C-reactive protein. A pulmonary embolus was diagnosed by computed tomography (CT) pulmonary angiography and he was treated with low molecular weight heparin. He received i.v. antibiotics (flucloxacillin, amoxicillin, gentamicin and metronidazole) for polymicrobial bacteraemia (methicillin-sensitive S taphylococcus aureus , Enterococcus , viridans type Streptococcus) caused by a right groin abscess, which was subsequently incised and drained, and was associated with iliofemoral thrombosis. No valvular vegetation was seen on transthoracic or subsequent transoesophageal echocardiogram. The patient had a fluctuating clinical course, requiring respiratory support with supplemental oxygen and noninvasive ventilation. He had a persistent neutrophil leukocytosis and greatly elevated C-reactive protein at >100 mg·L−1. Clinically, there was evidence of bilateral pleural effusions, which cultured Enterococcus on aspiration. Attempted thoracocentesis was unsuccessful with minimal fluid drained. An ultrasound scan of the chest revealed loculated pleural effusions. He continued to cough blood and 17 days after admission had an episode of massive haemoptysis requiring a blood transfusion. At this point the anticoagulation was discontinued given the risk of further massive haemoptysis. A repeat CT of the chest was performed to clarify the cause of the continuing haemoptysis (fig. 1⇓). Despite halting the anticoagulation, further fresh haemoptysis occurred a few days later and he was referred to a cardiothoracic surgeon with a view to surgical intervention. Due to …

Extraspinal Ependymoma: An Unusual Cause of Deep Vein Thrombosis

Introduction Extrinsic compression of the iliac veins by neoplasms is a rare cause of deep vein thrombosis (DVT). We report a case of DVT heralding the presence of an unusual tumour, an extraspinal ependymoma. Report A 39 year old female presented with a left leg DVT, initially presumed to be idiopathic. However, subsequent investigations indicated by persisting symptoms revealed a rare pelvic tumour obstructing the left iliac vein. Discussion We review the current literature surrounding ilio-femoral thrombosis caused by extrinsic compression and venous stasis. To our knowledge, DVT caused by an extra-spinal ependymoma has not been reported in the past. Extraspinal Ependymoma: An Unusual Cause of Deep Vein ThrombosisEJVES ExtraVol. 13Issue 5PreviewExtrinsic compression of the iliac veins by neoplasms is a rare cause of deep vein thrombosis (DVT). We report a case of DVT heralding the presence of an unusual tumour, an extraspinal ependymoma. Full-Text PDF Open Access

Extraspinal Ependymoma: An Unusual Cause of Deep Vein Thrombosis

Extrinsic compression of the iliac veins by neoplasms is a rare cause of deep vein thrombosis (DVT). We report a case of DVT heralding the presence of an unusual tumour, an extraspinal ependymoma. A 39 year old female presented with a left leg DVT, initially presumed to be idiopathic. However, subsequent investigations indicated by persisting symptoms revealed a rare pelvic tumour obstructing the left iliac vein. We review the current literature surrounding ilio-femoral thrombosis caused by extrinsic compression and venous stasis. To our knowledge, DVT caused by an extra-spinal ependymoma has not been reported in the past.

Successful Iliac Vein and Inferior Vena Cava Stenting Ameliorates Venous Claudication and Improves Venous Outflow, Calf Muscle Pump Function, and Clinical Status in Post-Thrombotic Syndrome

Stent therapy has been proposed as an effective treatment of chronic iliofemoral (I-F) and inferior vena cava (IVC) thrombosis. The purpose of this study was to determine the effects of technically successful stenting in consecutive patients with advanced CVD (CEAP3-6 +/- venous claudication) for chronic obliteration of the I-F (+/-IVC) trunks, on the venous hemodynamics of the limb, the walking capacity, and the clinical status of CVD. These patients had previously failed to improve with conservative treatment entailing compression and/or wound care for at least 12 months. The presence of venous claudication was assessed by > or =3 independent examiners. The CEAP clinical classification was used to determine the severity of CVD. Outflow obstruction [Outflow Fraction at 1- and 4-second (OF1 and OF4) in %], venous reflux [Venous Filling Index (VFI) in mL/100 mL/s], calf muscle pump function [Ejection Fraction (EF) in %] and hypertension [Residual Venous Fraction (RVF) in %], were examined before and after successful venous stenting in 16 patients (23 limbs), 6 females, 10 males, median age 42 years; range, 31-77 yearas, left/right limbs 14/9, using strain gauge plethysmography; 7/16 of these had thrombosis extending to the IVC. Contralateral limbs to those stented without prior I-F +/- IVC thrombosis, nor infrainguinal clots on duplex, were used as control limbs (n = 9). Excluded were patients with stent occlusion or stenoses, peripheral arterial disease (ABI <1.0), symptomatic cardiac disease, unrelated causes of walking impairment, and malignancy. Preinterventional data (< or =30 days) were compared with those after endovascular therapy (8.4 months; interquartile range [IQR], 3-11.8 months). Nonparametric analysis was applied. Compared with the control group, limbs with I-F +/- IVC thrombosis before stenting had reduced venous outflow (OF4) and calf muscle pump function (EF), worse CEAP clinical class, and increased RVF (all, P < 0.05). At 8.4 months (IQR, 3-11.8 months) after successful I-F (+/-IVC) stenting, venous outflow (OF1, OF4) and calf muscle pump function (EF) had both improved (P < 0.001) and the RVF had decreased (P < 0.001), at the expense of venous reflux, which had increased further (increase of median VFI by 24%; P = 0.002); the CEAP status had also improved (P < 0.05) from a median class C3 (range, C3-C6; IQR, C3-C5) [distribution, C6: 6; C4: 4; C3: 13] before intervention to C2 (range, C2-C6; IQR, C2-C4.5) [distribution, C6: 1; C5: 5; C4: 4; C2: 13] after intervention. At this follow up (8.4 months median), venous outflow (OF1, OF4), calf muscle pump function (EF), and RVF of the stented limbs did not differ significantly from those of the control; significantly worse (P < 0.025) were the amount of venous reflux (VFI), and the CEAP clinical class, despite the improvement with stenting. Incapacitating venous claudication noted in 62.5% (10 of 16, 95% CI, 35.8%-89.1%) of patients (15 of 23 limbs; 65.2%, 95% CI, 44.2%-86.3%) before stenting was eliminated in all after stenting (P < 0.001). Successful I-F (+/-IVC) stenting in limbs with venous outflow obstruction and complicated CVD (C3-C6) ameliorates venous claudication, normalizes outflow, and enhances calf muscle pump function, compounded by a significant clinical improvement of CVD. The significant increase in the amount of venous reflux of the stented limbs indicates that elastic or inelastic compression support of the successfully stented limbs would be pivotal in preventing disease progression.