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Shaking our foundations

      In their most recent publication,
      • Jayaraj A.
      • Powell T.
      • Raju S.
      Utility of the 50% stenosis criterion in patients undergoing stenting for chronic iliofemoral venous obstruction.
      the RANE group has taken on what was a standard threshold for deep venous intervention, >50% stenosis by intravascular ultrasound examination. As they eloquently describe, they found in a large sample that degree of stenosis does not reliably predict symptoms, ulceration, or foot pressures. Their conclusion is that it is possible to have clinically significant venous obstruction at less than 50% stenosis and that stenting of this obstruction leads to the same improvements that we can expect in patients with a high-grade stenosis (>50%). This is a huge contribution to the field as it may get us closer to providing appropriate interventions that heal ulcers and improve daily life in suffering patients who previously did not meet criteria for stenting. With this demonstration we are now forced to rethink our practices and determine how to most appropriately treat. This leads us back to a core tenant of venous care—listening to the patient. Careful documentation and diligent use of quality of life scores will be more important than ever if we downgrade the dictum of a greater than 50% stenosis as a necessary component in the decision of whether to treat venous obstructive disease.
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      References

        • Jayaraj A.
        • Powell T.
        • Raju S.
        Utility of the 50% stenosis criterion in patients undergoing stenting for chronic iliofemoral venous obstruction.
        J Vasc Surg Venous Lymphat Disord. 2021; 9: 1408-1415
        • Masuda E.
        • Ozsvath K.
        • Vossler J.
        • Woo K.
        • Kistner R.
        • Lurie F.
        • et al.
        The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology.
        J Vasc Surg Venous Lymphat Disord. 2020; 8: 505-525

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