Clinical efficacy of combined treatment for lower extremity venous reflux and iliac vein obstruction

Abstract

Background

Chronic venous disease (CVD) arises from venous obstruction, reflux, or both. Iliac vein stenting is standard for obstructive lesions, but the incremental benefit of concurrently treating deep venous reflux remains uncertain. We evaluated the efficacy of combining iliac vein stent placement with deep venous valve reconstruction in CVD patients presenting with both iliac obstruction and reflux.

Methods

From October 2015 to May 2025, we retrospectively analyzed a prospectively maintained cohort of 74 patients with lower-limb CVD and iliac vein stenosis and stratified them by reflux pattern: Group 1 (n = 14), iliac obstruction + superficial venous reflux; Group 2 (n = 16), iliac obstruction + deep venous reflux; Group 3 (n = 44), iliac obstruction + both deep and superficial venous reflux. Outcomes included Venous Clinical Severity Score (VCSS), ulcer healing, and complications.

Results

All groups showed symptomatic improvement with significant VCSS reductions. Patients in Group 3, who received comprehensive management for iliac obstruction and both deep and superficial reflux, showed numerically more favorable outcomes than the other groups. Among 27 patients with active ulcers, the overall healing rate was 85.2%; those undergoing deep venous valve reconstruction had higher healing rates and shorter time to closure. Primary patency of iliac stents was 98.3%, and no major complications were observed.

Conclusions

In CVD with coexisting iliac obstruction and venous reflux, a combined strategy—iliac stenting plus deep venous valve reconstruction—was associated with greater clinical improvement and a shorter time to complete ulcer healing compared with treating obstruction alone. This approach appears safe, maintains high stent patency, and may optimize outcomes in complex CVD.