Diagnosis and endovascular treatment of iliac venous compression syndrome

Abstract

Objectives

To report

*The first two authors contributed equally to this work.

our clinical experience on diagnostic criteria and endovascular management in patients with iliac venous compression syndrome.

Method

Between July 2013 and May 2015, 85 consecutive patients with suspected iliac venous compression syndrome were evaluated by transfemoral venography and intravascular ultrasonography. Venographic evidence of iliac venous occlusion, stenosis, or pelvic collateral vessels, and the degree of stenosis as examined with intravascular ultrasonography were recorded. The endovascular procedure, complications, clinical outcome, and the Venous Clinical Severity Score were evaluated before and after the intervention.

Results

Of the 85 limbs, 66 cases of iliac venous compression syndrome were confirmed and 19 cases were excluded. In all of the 66 patients, we successfully performed endovascular intervention (22 balloon dilations, 44 balloon dilations + stenting). Two patients with stent implantation developed acute lower extremity deep vein thrombosis, resulted in successful lysis of the thrombus with catheter-directed thrombolysis.

Conclusions

The presence of intraluminal spurs and pelvic collateral vessels represents not only pathological and anatomical changes by long-term mechanical compression, but also indicators of the severity of iliac venous compression syndrome. The degree of stenosis cannot accurately represent the severity and treatment of iliac venous compression syndrome, especially in the right iliac vein. Endovascular intervention is a safe and effective treatment that reduces lower extremity symptoms. Full and intentional dilation of the intraluminal spurs is an important technical aspect, which is often ignored.

Keywords

Iliac venous compression syndrome stent intravascular ultrasonography venography

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References

Ahmed

Hagspiel

. Intravascular ultrasonographic findings in May-Thurner syndrome (iliac vein compression syndrome). J Ultrasound Med Off J Am Inst Ultrasound Med 2001; 20: 251–256.

May

Thurner

. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology 1957; 8: 419–427.

Raju

Neglen

. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg 2006; 44: 136–143.

Burke

Rayan

Kasirajan

et al.

Unusual case of right-sided May-Thurner syndrome and review of its management. Vascular 2006; 14: 47–50.

Abboud

Midulla

Lions

et al.

“Right-sided” May-Thurner syndrome. Cardiovasc Interv Radiol 2010; 33: 1056–1059.

Brazeau

Harvey

Pinto

et al.

May-Thurner syndrome: diagnosis and management. VASA Zeitschrift fur Gefasskrankheiten 2013; 42: 96–105.

Neglen

Hollis

Olivier

et al.

Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg 2007; 46: 979–990.

Vasquez

Rabe

McLafferty

et al.

Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg 2010; 52: 1387–1396.

Eklof

Rutherford

Bergan

et al.

Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40: 1248–1252.

10.

Oguzkurt

Ozkan

Ulusan

et al.

Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol JVIR 2008; 19: 366–370.

11.

Englund

. Towards a classification of Left Iliac vein compression based on triplanar phlebography. Surg Sci 2017; 8: 19–26.

12.

Mahnken

Thomson

de Haan

et al.

CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Interv Radiol 2014; 37: 889–897.

13.

Neglen

. Chronic venous obstruction: diagnostic considerations and therapeutic role of percutaneous iliac stenting. Vascular 2007; 15: 273–280.

14.

Neglen

Raju

. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg 2002; 35: 694–700.

15.

Forauer

Gemmete

Dasika

et al.

Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol JVIR 2002; 13: 523–527.

16.

et al.

The preliminary application of intravascular ultrasound in the diagnosis and treatment of iliac vein compression syndrome. Chin J Gen Surg 2015; 30: 406–407.

17.

Hartung

Loundou

Barthelemy

et al.

Endovascular management of chronic disabling ilio-caval obstructive lesions: long-term results. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg 2009; 38: 118–124.

18.

Kolbel

Lindh

Akesson

et al.

Chronic iliac vein occlusion: midterm results of endovascular recanalization. J Endovasc Ther Off J Int Soc Endovasc Spec 2009; 16: 483–491.

19.

Seager

Busuttil

Dharmarajah

et al.

Editor’s choice – a systematic review of endovenous stenting in chronic venous disease secondary to iliac vein obstruction. Eur J Vasc Endovasc Surg 2016; 51: 100–120.

20.

Sang

Qian

et al.

Outcome of endovascular treatment in postthrombotic syndrome. Ann Vasc Surg 2014; 28: 1493–1500.

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