KIMS Hospitals, Thane Restores Mobility in 26-Year-Old with Chronic Painful Varicose Veins ulcer Using IVUS-Guided venous Stenting, delivering 90% Pain Relief and Swelling Reduction in Just 48 Hours
For nearly five years, a 26-year-old male from Ulhasnagar lived with chronic leg pain, swelling, and a non-healing ulcer — the visible symptoms of recurring varicose veins. He had already undergone three procedures, including bilateral endovenous laser ablation (EVLA) and even an open surgery on the right leg. Yet, his condition deteriorated. The wound refused to heal, the pain worsened, and his ability to work and earn a living was severely compromised. It was only during his fourth intervention — at our vascular surgery unit — that the true underlying cause came to light.
Initial tests and superficial treatments had failed to address what lay beneath — a case of non-thrombotic iliac vein lesion (NIVL), previously called May-Thurner Syndrome. In this condition, the left common iliac vein is compressed between the right common iliac artery and the spine, leading to a chronic, underdiagnosed form of deep vein insufficiency. This developmental abnormality had gradually worsened as the patient aged, culminating in severe venous outflow obstruction. Despite standard imaging techniques and previous interventions, the diagnosis had been repeatedly missed. A closer look using advanced diagnostic modalities revealed the real picture.
At our center, the turning point came with the use of Intravascular Ultrasound (IVUS) — a minimally invasive yet powerful tool that allowed real-time, intraluminal visualization of the vein. IVUS revealed significant compression of the iliac vein that was not clearly evident on MRI or CT venography. Unlike traditional contrast studies, IVUS helped determine the exact site and degree of compression with precision.
Once the diagnosis was confirmed, the patient underwent balloon venoplasty, wherein a 14–16 mm balloon was used to open the compressed vein. However, a recoil was observed immediately afterward, indicating persistent compression. To ensure long-term patency, a dedicated self-expanding venous stent was deployed in the affected segment. The procedure was smooth, took less than an hour, and the results were immediate. Pain vanished within 24 hours. Swelling subsided in 48 hours. The patient, now fitted with compression stockings, was back on his feet, pain-free and able to resume his daily work — something he hadn’t been able to do for years.
This case is a reminder that chronic venous insufficiency in young patients — particularly those with recurrent ulcers and varicose veins — may have a proximal, deep vein pathology. Treating only the superficial system, as was done in this patient’s earlier interventions, is often insufficient when the root cause lies deeper.
“In cases of unexplained recurrent venous disease, especially in younger individuals, we must look beyond the surface. IVUS allows us to see what traditional imaging cannot — and that can make all the difference between temporary relief and permanent resolution,” says Dr. Ritesh Gaikwad, Consultant Vascular & Endovascular Surgeon, KIMS Hospitals, Thane.
This patient’s journey — from years of unsuccessful surgeries to rapid recovery after a single, targeted intervention, underscores the importance of proper diagnosis and the evolving role of intravascular imaging in venous disease. The availability of IVUS and modern venous stents has redefined how we approach chronic venous insufficiency and offers a renewed promise of lasting relief for patients who have long suffered in silence.