Proximal venous outflow obstruction associated with chronic lower back pain


An unexpected prevalence of chronic lower back pain (CLBP) was found among patients with proximal venous outflow obstruction (PVOO), according to Windsor Ting, MD, of the Icahn School of Medicine at Mount Sinai, New York and colleagues.

On Friday morning, Dr. Ting will present a study they performed to assess 168 consecutive patients (59% women; mean age 63 years) with PVOO who underwent iliac vein stent placement. PVOO was confirmed with venography and/or IVUS. The patients were queried regarding preoperative and postoperative CLBP, defined as consistent low back pain of a minimum 3-month duration.

They collected data on demographics, venous-related symptomatology, pain scores (0-10) as determined by a visual analog scale (VAS), characteristics of the CLBP. In addition, details of the vein stent procedure were collected.

The mean postoperative duration among the patients was 526 days. Preoperative CLBP was present in 104 (62%) patients; 29 (28%) used analgesics and 38 (37%) had a prior visit with a CLBP specialist. Standing (44%) and sitting (43%) were the two most common factors associated with CLBP pain exacerbation.

Dr. Ting will discuss how CLBP was unexpectedly prevalent among patients with PVOO prior to their iliac vein stent placement, and how their pain was significantly improved after iliac vein stent placement, with 32% of the patients reporting complete symptom resolution. This study is the first to report these unexpected findings, according to the researchers, but the pathophysiology of CLBP in PVOO is unclear.

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