The Role of Iliofemoral Vein Compression in Diabetic Foot Ulceration

NewsBot · Jun 1, 2019

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The Role of Iliofemoral Vein Compression in
Diabetic Foot Ulceration
Vivek Prakash, Jesse Chait, Kevin Chun, Ageliki Vouyouka, Rami O.
Tadros, Michael L. Marin, Peter L. Faries, Windsor Ting. Icahn School
of Medicine at Mount Sinai, New York, NY
Abstract

Objective: Diabetic foot disease accounts for $6 billion in annual
health care spending, and 80% of diabetes-related lower extremity
amputations are preceded by a diabetic foot ulcer (DFU). DFU is caused
by a combination of peripheral artery disease and neuropathy; however,
there is a paucity of research on the impact of chronic venous insufficiency on the development and natural history of DFU. Furthermore,
there are no standardized methods for evaluating the presence and
severity of iliofemoral vein compression, a major cause of chronic
venous insufficiency. This study aimed to identify the prevalence and
severity of iliofemoral vein compression in patients with DFU using
cross-sectional imaging.
Methods: This was a retrospective analysis of 100 consecutive patients
with a documented diagnosis of DFU who underwent some form of
abdominopelvic cross-sectional imaging. Each patient’s demographics,
past medical history, DFU laterality, and major limb adverse events
were collected. Documented cross-sectional imaging parameters
included imaging modality, anatomic location, and quantitative measurements of the maximum and minimum vein diameters. A patient
was defined as having iliofemoral vein compression if the location of minimum diameter was located more proximal to the location of maximum
diameter. There were 57 patients excluded because of lack of a
confirmed diagnosis of diabetes mellitus or absence of evidence of ulceration despite a documented DFU.
Results: There were 43 patients included in analysis, of which 63% were
male. The average age at time of imaging was 64.7 years. Of these patients, 88% were insulin-dependent diabetics, with a mean hemoglobin
A1c level of 7.32%; 60% of patients had bilateral ulcers, 12% had isolated
left lower extremity (LLE) ulcers, and 29% had isolated right lower extremity ulcers. There were a total 18 left and 23 right lower extremity amputations; 84% of patients had radiographic evidence of left-sided
iliofemoral vein compression, whereas only 30% of patients had rightsided compression (P ¼ .000001). The ratio of maximum-minimum
vessel diameter was used to quantify the severity of vein compression.
The average left-sided ratio in patients who underwent LLE amputation
was 2.70, whereas the ratio in those without LLE amputation was 2.20
(P ¼ .046). There was no significant difference in right-sided ratio and incidence of amputation (2.05 vs 2.22; P ¼ .22).
Conclusions: This study describes a novel method of identifying iliofemoral vein compression using cross-sectional imaging. A significant predisposition of left-sided iliofemoral vein stenosis was found in patients
with DFU, with the extent of left-sided iliofemoral vein compression
correlated with a higher risk of amputation. Further investigation is
warranted.
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