Abstract
BACKGROUND: The efficacy of suprainguinal venous interventions in the management of venous ulceration, after the elimination of infrainguinal superficial venous reflux, is currently ill-defined. The purpose of this investigation was to assess the role of venous stenting and prior infrainguinal superficial vein interventions in the management of patients with nonhealing and/or recurrent venous ulcers. METHODS: A retrospective cohort analysis of prospectively collected data from November 2019 to December 2024 on nonhealing or recurrent venous ulcer female patients treated with iliac vein stenting. Patient demographics, Revised Venous Clinical Severity Score, visual analog scale scores, number and types of superficial vein procedures in the index and contralateral limbs before stenting, ulcer size, duration, time to healing, reintervention rates, and types of reinterventions were assessed. RESULTS: Fifty patients met the inclusion criteria. All were female with an average age of 66.7 ± 12.6 years and body mass index of 37.8 ± 8.2. The average Revised Venous Clinical Severity Score was 11.7 ± 4.8 on the left and 9.2 ± 4.3 on the right. Ulcers were in the left limb in 36 and the right limb in 14. The primary symptom on initial presentation was an active ulcer in 60% of patients. The remaining 40% presented with symptoms of chronic venous insufficiency secondary to symptomatic infrainguinal superficial vein reflux. In these patients, the time from initial patient encounter to the development of an ulcer was 617 ± 1353 days. Ulcer duration before diagnosis was 4.4 ± 4.2 months and 17 patients reported the ulcers were recurrent. Average ulcer size was 23.7 ± 37.2 cm(2). Ulcers healed in 30 patients after stenting. Nonhealing was seen in 19 patients (38%) at ≤2 years after stenting; one patient was lost to follow-up. Multivariate analysis indicated that nonhealing was associated with ulcer size of >7 cm(2) (odds ratio [OR], 0.96; 95% confidence interval, 0.92-0.99; P ≤ .03) and suggested that prior elimination of infrainguinal superficial vein reflux in the index limb was associated with improved healing after stenting (OR, 5.06; 95% confidence interval, 0.942-27.21; P ≤ .06). Average time to healing was 261.9 ± 301.6 days. Before stenting, superficial interventions in the index limb were performed in 36 patients and contralateral limbs in 25 patients. Average area reduction on intravascular ultrasound examination was 66.2 ± 11.1 cm(2), stent diameters reduction was 15.3 ± 1.2 mm, stent lengths reduction was 133.6 ± 25 mm, and the average number of reinterventions was 9 out of the 50 patients (18%). The average time to reintervention was 18.3 ± 18.3 months. Stent types were 30 Venovo, 19 Abre, and 1 Wallstent. CONCLUSIONS: Venous ulcer patients have chronic disease, with the majority reporting undergoing superficial interventions for 2 to 4 years before stenting. After iliac vein stenting, 60% of ulcers demonstrated complete ulcer healing, with 80% of those healed by 1 year. Ulcer healing is directly related to ulcer size and is associated with improved healing when infrainguinal superficial reflux is eliminated.