الفهرس 
INTRODUCTION AND AIM OF THE WORK
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Chronic venous disease (CVD) of the legs is common in the whole world. It causes considerable morbidity in the population and treatment incurs significant costs to the health service. Knowledge on the epidemiology of CVD is essential in order to identify which patients will benefit most from treatment to slow or halt the progression of disease. CVD can result from primary or secondary causes, for example where CVD occurs after deep vein thrombosis (DVT) and it is known as the post-thrombotic syndrome (PTS), or from extrinsic iliac vein compression and it is known as non- thrombotic iliac vein lesions (NIVLs).
Patients initially seek treatment to relieve symptoms of leg pain, discomfort, heaviness and swelling, all of which impact their quality of life. As the disease increases in severity to include varicose veins, skin changes, and venous ulcer, the demand for treatment increases while the quality of life further diminishes.
During the past decade, percutaneous transluminal venoplasty and stenting have become established treatments for chronic obstruction of the iliac and caval veins in a growing number of centres worldwide. Endovenous reconstruction of chronic iliocaval obstruction is one of the more challenging of all major endovascular procedures. The endovascular alleviation of the obstruction requires interventional skills with percutaneous techniques, familiarity with dedicated various venous stents, and experienced judgment in selection and placement of the venous stents.
This treatment for patients with chronic outflow lesions has been considered as an alternative to symptom reduction by conservative compression treatment if later failed. Compared to bypass procedures it is relatively simple, has low risk, can be performed as a day case procedure, excellent stent patency rates are reported and potentially has better symptom improvement.
Aims
This work aimed:
• To assess the patency and clinical outcome after recanalization and stenting in PTS and NIVL patients in whom conventional treatment had failed.
• To evaluate the quality of life improvement among CVI patients after successful management.
Methods
This study was conducted prospectively on 33 patients with chronic deep venous diseases (either NIVL or PTS) due to presence of venous outflow lesions. These patients presented to Vascular Surgery Department, charing Cross Hospital, Imperial College Healthcare NHS Trust, London, England and Vascular Surgery Department, Faculty of Medicine, Assiut, Egypt from June 2016 to September 2018.
Results
Thirty-three patients with 43 limbs (19 females, 14 males; median age, 44.3 years; range, 18-75) were included and all had successful recanalization and stent deployment. A complete history and physical examination were performed for all included patients to establish a proper diagnosis of CVD and appropriate evaluation for the impact of CVD on patient’s quality of life preoperatively , as well as assessment of daily activity improvements after endovenous procedures during each postoperative follow up visits at 2 weeks,1.5,3,6 and 12 months. Patients underwent both laboratory and different venous imaging investigations including duplex scan, CTV, MRV or ascending venogram.
Recanalization and stent placement were technically successful in all 43 limbs. Endovenous procedures have been performed under general anaesthesia in 22 patients and sedation plus local anaesthesia in the remaining 11 patients. The cumulative patency was high, with a primary patency rate of 75% and an assisted primary patency of 83%. Secondary patency rate was 90%. Mean Villalta score significantly decreased from baseline compared with that at 2, 6 and 12 months after the procedure [9.6 , 6.5 & 5.8, respectively, P<0.0001], indicating a significant decrease in the severity of PTS. VCSS score significantly decreased from baseline compared with that at 2, 6 and 12 months after stenting [9.0, 7.1, 6.4 & 6.0, respectively, P<0.0001] thus indicating a significant improvement of quality of life. A statistically significant improvement in quality of life scores (VEINESQOL/ Sym scores) was observed in all patients as compared with the baseline at 2, 6 and 12 months after stenting [53.7 , 63.4, 69.0 &
72.3 , respectively, P<0.05].
Conclusions
Our results confirm the significant impact of stenting on the quality of life of patients with chronic symptomatic ilio-femoral venous obstructive lesions with high cumulative patency rate, making it a viable treatment option.