Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction The efficacy of surpa-inguinal venous interventions in the management of venous ulceration, after the elimination of infra-inguinal superficial venous reflux, is currently ill defined. The purpose of this investigation is to assess the role of venous stenting and prior infra-inguinal superficial vein interventions, in the management of patients with non-healing and/or recurrent venous ulcers. Methods A retrospective cohort analysis of prospectively collected data from November 2019 to December 2024 on non-healing or recurrent venous ulcer female patients treated with iliac vein stenting. Patient demographics, rVCSS, visual analog scores (VAS), number and types of superficial vein procedures in the index and contralateral limbs prior to stenting, ulcer size, duration, time to healing, re-intervention rates and types of re-interventions were assessed. Results Fifty patients met inclusion criteria. All were female with an average age and BMI of 66.7±12.6 years and 37.8±8.2 respectively. Average rVCSS was 11.7±4.8 (left) and 9.2±4.3 (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 infra-inguinal superficial vein reflux. In these patients, the time from initial patient encounter to the development of an ulcer was 617±1353 days. Ulcer duration prior to diagnosis was 4.4±4.2 months and 17 patients reported the ulcers were recurrent. Average ulcer size was 23.7±37.2 square centimeters. Ulcers healed in 30 patients after stenting. Non-healing was seen in 19 (38%) patients up to two years after stenting and one was lost to follow-up. Multivariate analysis indicated that non-healing was associated with ulcer size greater than 7 square centimeters (OR, 0.96; 95% confidence interval, 0.92-0.99; p≤0.03) and suggested that prior elimination of infra-inguinal 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≤0.06). Average time to healing was 261.9±301.6 days. Prior to stenting, superficial interventions in the index limb were performed in 36 patients and contralateral limbs in 25 patients. Average area reduction by IVUS, stent diameters, lengths and number of reinterventions were 66.2±11.1 square centimeters, 15.3±1.2 millimeters, 133.6±25 millimeters and 9/50 (18%) respectively. Average time to reintervention was 18.3±18.3 months. Stent types were 30 Venovo, 19 Abre and one Wallstent. Conclusions Venous ulcer patients have chronic disease and the majority reported receiving superficial interventions for two to four years prior to stenting. After iliac vein stenting, 60% of ulcers demonstrated complete ulcer healing with 80% healed by one year. Ulcer healing is directly related to ulcer size and is associated with improved healing when infra-inguinal superficial reflux is eliminated.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,400
OpenAlex ID: W7143654305