Authors: Tae An Choi ANP-BC, Nay Htyte MD FACC, & Back Kim MD FACC.
Heart Vein NYC, New York, New York
Figure 1: venous stasis ulcers of both ankles
63-year-old male non-smoker with past medical history of deep vein thrombosis (DVT) of left leg 20 years ago, presented with 3 months of non-healing, painful, debilitating venous ulcers of bilateral lower legs that had been recurrent for two decades.
As noted in figure 1-3, there are multiple ulcers at the both ankles with whitish, macerated (soften skin by soaking in excessive fluid), irregular border an exudative reddened base, surrounded by brownish skin (due to the deposit of blood materials such as fibrin, iron and chronic inflammatory process of the tissue secondary to venous hypertension and incompetent valves).
Figure 2: Right lower leg
Figure 3: Left lower leg
He suffers from debilitating venous claudication symptoms described as achiness, heaviness, tension ad throbbing pain, in both calves and thighs that radiates up to buttock upon walking 1 block or standing 5~10 minutes, significantly limiting the activities of daily living such as grocery shopping and commuting. He has previously been treated with compression stockings without appropriate relief.
Bilateral femoral-iliocaval venogram and subsequent evaluation using intravenous ultrasound (IVUS) were performed, which revealed old thrombosis and severe narrowing at both iliac veins compared to respective normal reference vessel lumens.
These post thrombotic lesions were caused by extrinsic compression at arterial-venous crossings, previously described as iliac vein compression. Both narrowed veins were treated simultaneously with iliac vein kissing stenting using double-barrel technique (figure 4), with immediate relief of his pain.
Figure 4: Successful kissing balloon inflation and simultaneous deployment of bilateral iliac vein stenting.
In the 3-week post-stent, his ulcers of both legs were completely closed with remarkable restore of activities of daily living and improved quality of life.
Figure 5: Completely healed ulcers of both ankles.
