1Elzein Mohamed, Ahmed, 1Millar Mills, Melosa, 1Kearns, Daniel, 1Mackinnon, Tina, 1Wilton, Emma, 1Wigham, Andrew
1Oxford University Hospitals, Oxford, United Kingdom
Management of chronic venous ulcers in ex-intravenous drug users is complex, with significant effects on patient QOL and healthcare costs. Although more than two-thirds of patients in a methadone treatment programme 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.
Material(s) and Method(s):
Clinical and follow-up data were retrospectively assessed. 5 patients (7 limbs) with venous obstruction and ulceration underwent attempted recanalisation and stenting over a 2 year period. 3 patients underwent venographic assessment but were not treated due to relapse of drug use
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 and 2 years was 60%. Primary assisted patency at 1 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.
Our results show these complex patients can be treated successfully with venous recanalisation and stenting. The disease pattern is challenging and different to typical post-thrombotic venous obstruction, almost invariably affecting the CFV and lower EIV often with poor in-flow vessels. Rigorous pre-procedure assessment and follow-up is key to obtaining good outcomes.