title: Thrombolysis and iliofemoral vein stent placement in cancer patients with lower extremity swelling attributed to lymphedema.
abstract: OBJECTIVE
  To assess the effects of iliofemoral vein stent placement on symptomatic lower extremity swelling (LES), presumed to be lymphedema, in patients with cancer.
  
  
  METHODS
  During the period 2005-2013, 62 patients (38 female; age, 60.4 y ± 15.4) with histology-proven metastatic disease and LES resistant to standard therapies were evaluated and found to have venous outflow obstruction. Stents were placed in the iliofemoral veins or inferior vena cava, or both, and evaluated by color Doppler ultrasound or contrast-enhanced computed tomography during the follow-up period. Patient symptoms were assessed using the Venous Disability Score (VDS) and the Galway Limb Swelling score, a patient-directed, 5-question symptom scoring system.
  
  
  RESULTS
  Stents were successfully placed in all patients. During the follow-up period, in-stent thrombosis occurred in 13 patients, and additional stents were placed in 3 patients to treat luminal narrowing. The mean VDS improved significantly (P < .05): from 3.0 ± 0 on the day of the procedure to 2.95 ± 0.22 on day 3, 2.0 ± 0.33 on day 7, and 1.87 ± 0.34 on day 30. The mean Galway Limb Swelling score also improved significantly (P < 0.001): from 3.6 ± 0.74 on the day of the procedure to 1.96 ± 0.91 on day 3, 1.06 ± 0.78 on day 7, and 0.6 ± 0.66 on day 30. During the follow-up period, 60 patients died as a result of their underlying malignancy (mean, 230 d; range, 5-1,080 d).
  
  
  CONCLUSIONS
  Iliofemoral or iliocaval venous stent placement may have a valuable role in patients with metastatic disease and symptomatic LES associated with venous obstruction.
authors.affiliation: Department of Interventional Radiology, Galway University Hospitals, Newcastle Road, Galway, Ireland.. Electronic address: gerard.osullivan2@hse.ie.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: O'Sullivan
authors.affiliation: Department of Palliative Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland.
authors.forename: Dymphna
authors.initials: D
authors.lastname: Waldron
authors.affiliation: Department of Palliative Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland.
authors.forename: Eileen
authors.initials: E
authors.lastname: Mannion
authors.affiliation: Department of Oncology, Galway University Hospitals, Newcastle Road, Galway, Ireland.
authors.forename: Maccon
authors.initials: M
authors.lastname: Keane
authors.affiliation: Department of Oncology, Galway University Hospitals, Newcastle Road, Galway, Ireland.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Donnellan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D035002:Lower Extremity / Q000000981:diagnostic imaging / Q000601:surgery; D008209:Lymphedema / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery; D020246:Venous Thrombosis / Q000150:complications / Q000628:therapy; D055815:Young Adult