Iliac-caval stenting in the obese. Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter [J Vasc Surg] Journal article

Title	Iliac-caval stenting in the obese.
Author(s)	Raju S, Darcey R, Neglén P
Institution	University of Mississippi Medical Center and River Oaks Hospital, USA. rajumd@earthlink.net
Source	J Vasc Surg 2009 Nov; 50(5):1114-20.
MeSH	Adult Aged Aged, 80 and over Angioplasty, Balloon Catheter Ablation Chronic Disease Combined Modality Therapy Female Humans Iliac Vein Laser Therapy Male Middle Aged Obesity Saphenous Vein Stents Time Factors Treatment Outcome Ultrasonography, Interventional Vascular Patency Venae Cavae Venous Insufficiency Young Adult
Abstract	BACKGROUND: Chronic venous insufficiency (CVI) in the obese, often with severe clinical manifestations, is increasingly encountered in clinical practice. The association has drawn special interest as the pathophysiology may be different from that seen in the non-obese. The disease poses special management problems in the obese as traditional conservative measures are seldom effective. Iliac-caval venous stenting has been effective in CVI management but applicability in the obese raises concerns regarding stent compression, morbidity and efficacy. METHODS: Results of iliac-caval stenting in 101 limbs of 87 patients are presented. Clinical features, venous test results, and outcome after stenting are reported with comparison to select relevant features in the non-obese limbs (n = 1513) that were stented over the same 11 year period. RESULTS: Bilateral clinical manifestations CVI were twice as common in the obese subset compared with the non-obese (28% vs 14% respectively, P = .0007), the incidence increasing with BMI. Resting and exercise femoral vein pressures were similar to the non-obese. Obstructive lesions of primary or postthrombotic origin similar to those seen in non-obese limbs were detected by intravascular ultrasound examination in 89% of limbs. Compression by increased intra-abdominal pressure associated with obesity was likely the mechanism of obstruction in 11% of the limbs. Iliac-caval venous stenting was found to be safe with no mortality (<30 days), low morbidity (deep venous thrombosis in 3%), high patency (86% cumulative at five years), and satisfactory clinical outcome. Sixty-eight percent and 46% of limbs showed cumulative improvement in pain and swelling respectively at 5 1/2 years after stenting, with 65% and 31% limbs achieving complete relief of these respective symptoms. Thirty of 45 limbs (58% cumulative) were free of dermatitis/ulcer at four years. CONCLUSION: The mechanism of venous obstruction in the obese is substantially similar to those in the non-obese. Primary or post-thrombotic lesions as seen in non-obese CVI cases are present in 89% of cases per IVUS examination. Compression of the venous outflow by adiposity/abdominal pressure may be a factor in 11%. Iliac-caval venous stenting is a satisfactory clinical option in the obese with severe CVI manifestations requiring speedy relief.
Language	eng
Pub Type(s)	Journal Article
PubMed ID	19878789

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