Patients with active venous leg ulcers at the time of iliac vein stenting require more reoperations

Peter V Cooke; Halbert Bai; Lucas C Collins; Logan D Cho; Elyssa Dionne; Vikram Vasan; Christopher Gonzalez; Jinseo Kim; Yeju Kang; Rami O Tadros; Windsor Ting

doi:10.1016/j.jvsv.2022.05.002

Patients with active venous leg ulcers at the time of iliac vein stenting require more reoperations

J Vasc Surg Venous Lymphat Disord. 2022 Nov;10(6):1304-1309. doi: 10.1016/j.jvsv.2022.05.002. Epub 2022 Jun 30.

Authors

Affiliations

¹ Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: peter.cooke@icahn.mssm.edu.
² Icahn School of Medicine at Mount Sinai, New York, NY.
³ Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.

PMID: 35779830
DOI: 10.1016/j.jvsv.2022.05.002

Abstract

Objective: An active venous leg ulcer (VLU) caused by lower extremity venous insufficiency is challenging to treat and will often recur after initially healing. In the present study, we compared the symptomatic outcomes and need for reoperation after iliac vein stenting (IVS) in patients with an active VLU (VLU+) and those without an active VLU (VLU-).

Methods: A single-institution database of patients with chronic venous outflow obstruction who underwent IVS from August 2011 to June 2021 was analyzed. Symptoms were quantified using the venous clinical severity score. The patients were divided into two cohorts: those with (VLU+) and without (VLU-) VLUs.

Results: A total of 872 patients (71 VLU+ and 801 VLU-) were identified. Many of the demographics and comorbidities differed between the two cohorts, and these variables were included in the multivariable analysis. On univariate analysis, the VLU+ cohort was more likely to need a major reoperation (odds ratio, 1.94; 95% confidence interval, 1.01-3.52; P = .036). However, on multivariable analysis, the difference was not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.55-2.40; P = .667). Additionally, the VLU+ cohort required a significantly greater mean total of reoperations (1.4 vs 1.0; P = .006) than the VLU- cohort. Comparatively, for patients who underwent at least one reoperation, the difference in the mean total number of reoperations was even greater for the VLU+ cohort (2.6 vs 1.8; P = .001). The results from the Kaplan-Meier log-rank test revealed no differences in the reintervention-free survival time (P = .980). Both cohorts experienced a durable mean reduction in the venous clinical severity score. The ulcer healing rates for the VLU+ cohort at 6, 12, 24, and 36 months were 38%, 47%, 52%, and 59%, respectively. The ulcer recurrence rates for the VLU+ cohort were 4%, 10%, 19%, and 30% at 6, 12, 24, and 36 months, respectively, with a median time to recurrence of 1.2 years.

Conclusions: Patients with active VLUs who underwent a first reintervention after initial IVS, on average, required an additional reintervention.

Keywords: Iliac vein stent; Reintervention; Ulcer healing; Ulcer recurrence; Venous ulcer.

MeSH terms

Humans
Iliac Vein* / diagnostic imaging
Iliac Vein* / surgery
Reoperation
Retrospective Studies
Stents
Ulcer
Varicose Ulcer* / therapy