Bilateral Iliac Vein Stenting without Contrast in a Patient with Venous Ulcer

Chronic Venous Insufficiency is caused by ambulatory venous hypertension of the lower extremities due to vein reflux, venous obstruction, or both. Venous outflow obstruction may play a role in patients with chronic venous ulceration who fail to improve despite conventional modalities of treatment including wound care and compression therapy. Modern imaging techniques, particularly intravascular ultrasound and percutaneous venous stenting using venography provide the ability to treat the obstructive component of the disease. We here describe an interesting case of a seventy one year-old female with chronic kidney disease stage 5 who underwent bilateral iliac vein stenting for severe obstruction for symptoms of non-healing left medial malleolus ulcer utilizing intravascular ultrasound and no contrast. Singla A, Hurtado CM and Attaran R* Department of Medicine, Section of Cardiology, Yale University, USA Attaran R, et al. Clinics in Surgery Vascular Surgery Remedy Publications LLC., | http://clinicsinsurgery.com/ 2016 | Volume 1 | Article 1033 2 iliac vein (reduction in area 75%) (Figure 1 and 2). No evidence of thrombosis or synechiae was seen. Given these findings we proceeded with bilateral iliac venoplasty and stenting. We pre-dilated the iliac veins with a 14 mm balloon. Next, we deployed a 16mm x 60 mm self expanding stent (Wallstent, Boston Scientific) in the right iliac vein and overlapping 16mm x 90mm and16mm x 60 mm self expanding stents (Wallstent, Boston Scientific) on the left (Figure 3 and 4). Both sides were post-dilated with a 16 mm balloon. The patient tolerated the procedure well and was discharged on an oral anti-coagulant. Within a week of the procedure there was less swelling and induration in her legs and by 4 weeks her medial malleolar ulcer had healed.