Utility of iliac vein stenting in elderly population older than 80 years.

BACKGROUND: The geriatric population aged 80 years and older with severe manifestations of chronic venous disease face diminishing therapeutic options. Self-applied compression is often not possible because of frailty or arthritis. Significant limb swelling diminishes mobility, affects independent living, and precipitates institutionalization. Limb ulceration and pain diminish quality of life at a time when it is paramount. Cellulitis uniquely poses septicemic risk in this age group. Family caregivers are often able to continue home care if the intensity of care can be reduced. Iliac vein stenting may have a role as it appears to be safe and effective in this advanced stage of life.

METHODS: Patients who had failed to respond to compression and desired palliation of continuing severe chronic venous disease symptoms were considered for iliac vein stenting. Intravascular ultrasound-guided stenting was carried out under fluoroscopy without venography in case of allergy to contrast material or decreased renal function. General anesthesia was used for better cardiopulmonary control.

RESULTS: A total of 107 limbs (12 bilateral) were treated with iliac vein stents during a 13-year period, representing 5% of all stented limbs. Median age was 83 years (80-96 years), and 10 were ≥ 90 years; 59% were post-thrombotic. Clinical, etiologic, anatomic, and pathologic classification was as follows: C2 (with pain), 3%; C3, 32%; C4, 33%; C5, 5%; and C6, 27%. Concurrent saphenous ablation was carried out in 28% when saphenous reflux was considered ancillary and not the main disease. There was no mortality. Reintervention was required in 20% of limbs for nonocclusive stent malfunction; 2% of stents occluded. Primary and primary-assisted duplex patency rates at 5 years were 52% and 90%, respectively. The visual analog scale score of pain improved from median 4 (0-9) to 0 (0-10) after stenting (P < .0001). Pain was completely relieved in 43% of limbs. Cumulative improvement in the pain score of at least 3 points was 71% at 6 years. Swelling (grade 0, none; grade 1, pitting; grade 2, ankle edema; grade 3, gross) improved from median 3 (0-3) to 1 (0-3) (P < .0001). Swelling completely resolved in 25% of limbs. Cumulative improvement of at least one grade of swelling (examination) was 63% at 6 years; 70% of limbs (n = 33) with prior cellulitis were relieved of recurrence after stent placement; 61% of active ulcers healed, and 37% of patients were able to discard stockings (P < .001).

CONCLUSIONS: Iliac vein stenting appears to offer a safe and effective option in octogenarians and nonagenarians when compression fails, is difficult, or is impossible.