A Case Series: The Role of Interventional Radiology in Chronic Venous Leg Ulceration in Intravenous Drug Users

Background: Management of chronic venous ulcers in exintravenous drug users is complex with significant effects on patient QOL and health care costs. Although more than two-thirds of patients in a methadone treatment program were found to have chronic venous insufficiency, limited published literature on the role of venous stenting in managing this group of patients exists. The main aim is to describe our experience and results in treating this patient group.

Materials and Methods: Clinical and follow-up data were retrospectively assessed. Five patients (seven limbs) with venous obstruction and ulceration underwent attempted recanalization and stenting over a 2-year period. Three patients underwent venographic assessment but were not treated due to relapse of drug use.

Results: Technical success (defined as successful crossing of the occluded venous segment and restoration of in-line flow) was 71% (5/7 limbs). Primary patency at 1 year and 2 years was 60%. Primary assisted patency at 1 year and 2 years was 80%. One stent repeatedly occluded and could not be salvaged due to very poor in flow. One stent needed relining due to stent fracture. All patients with patent stents reported healing of ulceration and no new ulcers. Additionally, there was significant improvement in swelling and pain.

Conclusion: Our results show these complex patients can be treated successfully with venous recanalization and stenting. The disease pattern is challenging and different to typical postthrombotic venous obstruction, almost invariably affecting the CFV and lower EIV often with poor in-flow vessels. Rigorous preprocedure assessment and follow-up are key to obtaining good outcomes.

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Artikel online veröffentlicht:
14. Dezember 2021