Patients With Active Venous Leg Ulcers At The Time Of Iliac Vein Stenting Require More Reoperations
Peter V. Cooke, BA, Halbert Bai, Elyssa Dionne, Vikram Vasan, BA, Logan Cho, Christopher Gonzalez, BA, Jinseo Kim, Yeju Kang, Rami O. Tadros, MD, Windsor Ting.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
OBJECTIVES: Active venous leg ulcers (VLU) caused by lower extremity venous insufficiency indicate a high disease burden and risk for infection. Our objective was to compare clinical outcomes and need for reoperation after iliac vein stenting in patients with VLU vs. those without VLU (non-VLU).
METHODS: A single institution database of patients undergoing iliac vein stenting from August 2011 to June 2021 was analyzed. Symptoms were quantified using the venous clinical severity score (VCSS) and clinical assessment score (CAS). Patients in VLU cohort had an active VLU at the time of the initial iliac vein stent procedure. Major reoperation was defined as any procedure using venography. Minor reoperations were defined as endovenous laser ablation and sclerotherapy.
RESULTS: Among 784 patients, we identified 67 (8.5%) with VLU and 717 (90.4%) non-VLU. The VLU cohort had a higher prevalence of hypertension (74.6% vs. 48.4% p=0.001), coronary artery disease (30.6% vs. 10.2%, p<0.001), and smoking history (35.8% vs. 19.8% p = 0.038) than the non-VLU cohort. The VLU cohort was older (mean age 67.1 vs. 61.0, p=0.001) and more likely to be male (55.2% vs. 41.7%, p=0.031). Ethnicity also differed significantly between these two cohorts (p<0.001) (Table 1). On univariable analysis, the VLU cohort was more likely to undergo a major reoperation (OR 1.98 [95% CI 1.03 - 3.63], p=0.032), but on multivariable analysis, this difference was not significant (OR 1.28 [95% CI 0.59 - 2.65], p=0.521). Additionally, the VLU cohort had significantly higher mean total reoperations (1.4 vs. 1.0, p=0.012) than the non-VLU cohort. Comparatively, for patients who underwent at least one reoperation, the difference in the mean total number of reoperations was even larger for the VLU cohort (2.6 vs. 1.8, p=0.001). Log-rank test revealed no difference in intervention-free survival time (p=0.44). Changes in the VLU CAS at post-operative follow up dates of 30 days, 90 days, and 6 months are featured in Table 1.
CONCLUSIONS: While many patients had resolution of VLUs after iliac vein stenting, this cohort was more likely to undergo major reoperation and on average required more total reoperations. 
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