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Combined saphenous ablation and iliac stent placement for complex severe chronic venous disease.
J Vasc Surg. 2006 Oct; 44(4):828-33.JV

Abstract

BACKGROUND

Severe chronic venous disease frequently has a complex pathophysiology. This study describes results after combined interventions to correct outflow obstruction and superficial reflux, even in the presence of deep venous reflux.

METHODS

Between 1997 and 2005, 99 limbs in 96 patients had percutaneous iliofemoral venous stenting combined with great saphenous vein (GSV) stripping (39 limbs), or percutaneous GSV ablation performed by radiofrequency (27 limbs) or laser (33 limbs). Clinical severity score in CEAP was C4 in 51 limbs, C5 in eight limbs, and C6 in 40 limbs; median age was 56 years (range, 27 to 87 years); left-right limb ratio, 2.3:1; female-male ratio, 1.8:1; primary-secondary etiology, 58:41. Perioperative investigations included visual analogue pain scale (VAS), degree of swelling (grade 0 to 3); quality-of-life questionnaire; venous filling index in milliliters per second (VFI90), venous filling time in seconds (VFT), percentage in ambulatory venous pressure drop (AVP), duplex Doppler scanning, and radiologic studies.

RESULTS

Clinical follow-up was performed in 97 (98%) of 99 for up to 5.5 years. Axial deep reflux was found in 27% (27/99). At least three venous segments were refluxing in 40% of limbs. Preoperative hemodynamic parameters reflected the presence of reflux and improved significantly (P < .01) after the procedure (VFI90, 3.8 to 2.3 mL/s; VFT, 11 to 16 seconds; AVP, 55% to 65%). No patients died, and the morbidity with endovenous GSV ablation was largely limited to ecchymosis and thrombophlebitis in the thigh area. Cumulative primary, assisted primary, and secondary stent patency rates at 4 years were 83%, 97%, and 97%, respectively. After treatment, limb swelling and pain substantially improved. The rate of limbs with severe pain (>or=5 on VAS) fell from 44% to 3% after intervention. Gross swelling (grade 3) decreased from 30% to 6% of limbs. Cumulative analysis showed sustained complete relief of pain (VAS = 0) and swelling (grade 0) after 4 years in 73% and 47% of limbs, respectively. Ulcers healed in 26 (68%) of 38 ulcerated limbs. Cumulative ulcer-healing rate was 64% at 48 months. All quality-of-life categories significantly improved after treatment.

CONCLUSION

The single-stage combination of percutaneous venous stenting and superficial ablation in patients with severe chronic venous disease is safe, gives excellent symptom relief and improvement of quality of life, and a well-maintained ulcer-healing rate. It seems logical to initially perform multiple minimally invasive interventions rather than open surgery. Any associated deep reflux can initially be ignored pending clinical response to the combined intervention.

Authors+Show Affiliations

River Oaks Hospital, Jackson, MS, USA. neglenmd@earthlink.netNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17012006

Citation

Neglén, Peter, et al. "Combined Saphenous Ablation and Iliac Stent Placement for Complex Severe Chronic Venous Disease." Journal of Vascular Surgery, vol. 44, no. 4, 2006, pp. 828-33.
Neglén P, Hollis KC, Raju S. Combined saphenous ablation and iliac stent placement for complex severe chronic venous disease. J Vasc Surg. 2006;44(4):828-33.
Neglén, P., Hollis, K. C., & Raju, S. (2006). Combined saphenous ablation and iliac stent placement for complex severe chronic venous disease. Journal of Vascular Surgery, 44(4), 828-33.
Neglén P, Hollis KC, Raju S. Combined Saphenous Ablation and Iliac Stent Placement for Complex Severe Chronic Venous Disease. J Vasc Surg. 2006;44(4):828-33. PubMed PMID: 17012006.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined saphenous ablation and iliac stent placement for complex severe chronic venous disease. AU - Neglén,Peter, AU - Hollis,Kathryn C, AU - Raju,Seshadri, PY - 2006/03/09/received PY - 2006/06/24/accepted PY - 2006/10/3/pubmed PY - 2006/10/27/medline PY - 2006/10/3/entrez SP - 828 EP - 33 JF - Journal of vascular surgery JO - J Vasc Surg VL - 44 IS - 4 N2 - BACKGROUND: Severe chronic venous disease frequently has a complex pathophysiology. This study describes results after combined interventions to correct outflow obstruction and superficial reflux, even in the presence of deep venous reflux. METHODS: Between 1997 and 2005, 99 limbs in 96 patients had percutaneous iliofemoral venous stenting combined with great saphenous vein (GSV) stripping (39 limbs), or percutaneous GSV ablation performed by radiofrequency (27 limbs) or laser (33 limbs). Clinical severity score in CEAP was C4 in 51 limbs, C5 in eight limbs, and C6 in 40 limbs; median age was 56 years (range, 27 to 87 years); left-right limb ratio, 2.3:1; female-male ratio, 1.8:1; primary-secondary etiology, 58:41. Perioperative investigations included visual analogue pain scale (VAS), degree of swelling (grade 0 to 3); quality-of-life questionnaire; venous filling index in milliliters per second (VFI90), venous filling time in seconds (VFT), percentage in ambulatory venous pressure drop (AVP), duplex Doppler scanning, and radiologic studies. RESULTS: Clinical follow-up was performed in 97 (98%) of 99 for up to 5.5 years. Axial deep reflux was found in 27% (27/99). At least three venous segments were refluxing in 40% of limbs. Preoperative hemodynamic parameters reflected the presence of reflux and improved significantly (P < .01) after the procedure (VFI90, 3.8 to 2.3 mL/s; VFT, 11 to 16 seconds; AVP, 55% to 65%). No patients died, and the morbidity with endovenous GSV ablation was largely limited to ecchymosis and thrombophlebitis in the thigh area. Cumulative primary, assisted primary, and secondary stent patency rates at 4 years were 83%, 97%, and 97%, respectively. After treatment, limb swelling and pain substantially improved. The rate of limbs with severe pain (>or=5 on VAS) fell from 44% to 3% after intervention. Gross swelling (grade 3) decreased from 30% to 6% of limbs. Cumulative analysis showed sustained complete relief of pain (VAS = 0) and swelling (grade 0) after 4 years in 73% and 47% of limbs, respectively. Ulcers healed in 26 (68%) of 38 ulcerated limbs. Cumulative ulcer-healing rate was 64% at 48 months. All quality-of-life categories significantly improved after treatment. CONCLUSION: The single-stage combination of percutaneous venous stenting and superficial ablation in patients with severe chronic venous disease is safe, gives excellent symptom relief and improvement of quality of life, and a well-maintained ulcer-healing rate. It seems logical to initially perform multiple minimally invasive interventions rather than open surgery. Any associated deep reflux can initially be ignored pending clinical response to the combined intervention. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/17012006/Combined_saphenous_ablation_and_iliac_stent_placement_for_complex_severe_chronic_venous_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)01145-1 DB - PRIME DP - Unbound Medicine ER -