We know what the ideologies which is anatomical and could be webs.
We know that post-thrombotics of thrombus as you see here than a non-thrombotics. We've talked a lot about the physiology of venous obstruction. We didn't tackle a lot
and we didn't talk and we did talk some resistance. But we know that arteries At present, it's possible significant arterial obstructions. No accurate tests to
significant venous obstruction. It's unknown at what is hemodynamically significant. And consequently, greater than or area/diameter reduction The recent researches you
maybe 61% diameter stenosis of clinical improvement. And in the United States, we're using these and these are the areas after we see a stenosis and
So if you look at the at 200, 100 would be But most important and I we need an objective
If we look at this Strong and Stenting of Thrombotic
the European Vascular Society as well as the Society of with criteria that are And it was Raju and his not only with the indications, how the patients did,
So if we look at this, the Virtus Study which that was produced by Veniti, you can see that 85% had some subjective or objective improvement of substantial improvement.
And in the Armsburg Trial showed similar improvements
So what supports using greater than 50% morphological stenosis And Dr. Razavi did a systematic he was able to show that
and you can see in a non-thrombotic that the edema portion but the pain relief was not. And that would speak volumes other mechanisms of pain. Stenting is not a panacea,
We know that. In the post-thrombotic disease, there's reflux and obstruction. You must test for both and I feel that it should especially in those patients that have
advanced clinical classification. In the non-thrombotics, I submit to you that about 30% have a May Thurner type lesion. It's multi-factorial in which will go into in the
may result in the subjective, but not objective relief of swelling.
It's multi-factorial in which will go into in the
may result in the subjective, but not objective relief of swelling. So let's look at some of these. Dr. Raju looked at patients lymphangiograms compared to those that had normal lymphangiograms.
There are 72 patients in that one arm and in the standard there are 205. If we look at this, we can in 45%, the abnormal and 66% in the normals. And there was a complete pain
with lymphedema and 71% without. But more importantly, if swelling relief, which is obvious in a lymphedema patient only had 16%. But that was still better than zero.
If we look at the relationship
with swelling, Dr. Raju 150 menopausal women, with a CEAP classification of 3. There's concomitant pain What he noticed was that with pain relief, complete with 65%
and if we look at, let's 65% had a complete relief but what was important, even complete in 33% and improved in 50%, the subjective improvement was 67%. Suggesting that improvement
result in subjective but not That being said, what will of venous stenting? We may have seen this showing an increase in the as well as superficial venous disease.
So stenting of non-thrombotics is readily easy procedure. There's minimal clinical risk to patients. Generally good results in patients with non-thrombotic lesions. Imaging modalities supports
of stenosis and reimbursement in the United States.
So this is what could happen. There is presently a witch-hunt in the United States and I am happen with stenting.
So what we need to do is be It's necessary to avoid So the overarching question right patients are treated? Patients receive more lymphedema, cardiac
failure, tricuspid regurgitation, muscle pump impairment and inactivity. Target intervention is severe by compression therapy. Concomitant symptoms such as to stent patients with swollen legs.
When intervention includes for correct stent placement. Appropriate follow-up, So the take home message stenting may be beneficial symptomatic chronic leg
Without a test for hemodynamic risk of over-treating patients Need better correlation between stenosis and clinical outcome. Since at least one-third of the patients have no swelling relief,
in the absence of other signs or symptoms, proceed with caution. Thank you very much. (audience clapping)
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