Iliac vein stenting in postmenopausal leg swelling

Abstract

Patients with postmenopausal leg swelling often have obstructive venous pathology even though suggestive venous history and other signs are often absent. Morbidity arises from painful swelling that affects mobility, quality of life, and ability of self-care at later stages of life. Outpatient percutaneous iliac vein stenting affords substantial symptom relief and improvement in quality-of-life measures. Recognition of the clinical complex as a distinct entity of venous origin may lead to greater awareness and effective treatment.

CIRSE Standards of Practice Guidelines on Iliocaval Stenting

“…-Predilatation is essential in chronic occlusions, particularly with modern purpose designed laser-cut selfexpanding stents. Some interventionalists perform predilatation up to the nominal diameter of the subsequently used stent [37,38]. Predilatation may be painful; this is normal and does not indicate impending rupture as it does in arterial interventions.…”

Relative importance of iliac vein obstruction in patients with post-thrombotic femoral vein occlusion

“…The diagnostic sensitivity of IVUS to iliac vein lesions is z 80%, with some lesions at tributary junctions escaping detection (or only partially visible) because the IVUS probe is not centered. 13,14 These lesions can be uncovered by waisting of the balloon during routine "sizing" of the iliac vein segments.…”

Algorithm-based approach to management of venous leg ulceration

“…All venous ulcers with either absent or adequately treated superficial reflux should undergo deep venous assessment [4]. Intravenous ultrasound has been reported to be the most sensitive and specific modality for deep vein obstructive disease [11,[19][20], however, it is not widely available, and up to 10% of significant stenotic lesions could be impervious to intravenous ultrasound and require trial balloon angioplasty to unmask stenosis [21,22]. Computed tomography/ magnetic resonance venogram could be done on an outpatient basis and provided a fairly accurate idea about deep venous obstructive pathology [23,24].…”