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Home > Press Center > Venous Stents May Have A Role in Venous Disease

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Jill Goodwin
Director of Communications
312-334-2308

Nonthrombotic iliac vein lesions (NIVL’s), which include webs and spurs, have a high prevalence and a broad demographic spectrum in patients with chronic venous disease (CVD), according to a study done by Seshadri Raju, MD and Peter Neglen, MD, from the University of Mississippi Medical Center and River Oaks Hospital in Flowood, Miss.

According to Dr. Raju, NIVL’s are not rare and are commonly found in the asymptomatic general population. They are not often visible in venograms. “The clinical syndrome (also known as May-Thurner syndrome, Cockett syndrome or Iliac Vein Compression syndrome) has been thought to be a relatively rare contributor of CVD, predominantly affecting the left lower extremity of young women,” said Dr. Raju. “Our study described the much broader disease profile that has emerged with the use of intravascular ultrasound (IVUS) for diagnosis and analyzed stent placement outcome in two specific NIVL subsets that may offer clues to their pathogenic role.”
Dr. Raju said the study indicates that these lesions may be permissive of future development of CVD, and stent placement alone without correction of associated reflux often provides relief in symptomatic patients. The research has been published in the July issue of the Journal of Vascular Surgery.

Among 4,026 patients with CVD symptoms spanning the range of clinical classes, IVUS examination was selectively carried out in severely symptomatic patients for specific indications. Iliac vein obstructive lesions were found in 938 limbs of 879 patients; 53 percent of the limbs had NIVL, 40 percent were post-thrombotic and seven percent a combination. Outcome of stent placement totaling 332 limbs in 319 patients in two NIVL subsets, one with and the other without associated distal limb reflux, were compared. Reflux was left untreated in the first subset.

The median age was 54 years (range 18-90). Female to male ratio was 4:1 and left to right leg ratio was 3:1. The study revealed that the NIVL lesions in the iliac vein occurred at the iliac artery crossing (proximal lesion) and also at hypogastric artery crossing (distal lesion), a new IVUS finding.

According to the researcher, venography was only 66 percent sensitive with 34 percent of venograms found “normal,”  while IVUS had a diagnostic sensitivity of more than 90 percent. The following cumulative results were observed at 30 months following stent placement, in  the NIVL+reflux and NIVL  without reflux subsets respectively: complete relief of pain 82 percent and 77 percent; complete relief of swelling 47 percent and 53 percent; complete stasis ulcer healing 67 percent and 76 percent; and overall clinical relief outcome 75 percent and 79 percent. These results are nearly identical between the two subsets even though distal reflux remained uncorrected in the NIVL plus reflux subset.