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The Journal of Cardiovascular Surgery Oct 2021Compression of the left common iliac vein by the overlying right common iliac artery is a benign anatomic abnormality in most individuals. However, in patients with... (Review)
Review
Compression of the left common iliac vein by the overlying right common iliac artery is a benign anatomic abnormality in most individuals. However, in patients with significant vein compression, outflow obstruction and chronic intraluminal venous damage may lead to May-Thurner Syndrome. This syndrome commonly manifests as unilateral left leg swelling or acute iliofemoral deep venous thrombosis. In addition to clinical findings, diagnosis is made with ultrasound, computed tomography venography, or magnetic resonance venography. The extent of compression of the iliac vein is best determined by venography with intravascular ultrasound. Symptoms and hemodynamic significance of the compression guides the ideal treatment approach. Iliocaval stenting has become the standard treatment for this condition and has promising patency rates and clinical outcomes. This review paper provided an overview of pathophysiology, and utility and limitations of the existing diagnostic modalities and treatment options in the management of May-Thurner Syndrome.
Topics: Angioplasty, Balloon; Humans; Iliac Vein; May-Thurner Syndrome; Recurrence; Stents; Thrombolytic Therapy; Treatment Outcome; Venous Thrombosis
PubMed: 33870678
DOI: 10.23736/S0021-9509.21.11889-0 -
Journal of Vascular Surgery. Venous and... Jan 2017
Topics: Humans; Iliac Vein; Stents; Venous Thrombosis
PubMed: 27987610
DOI: 10.1016/j.jvsv.2016.11.002 -
Journal of Vascular Surgery. Venous and... Nov 2020
Topics: Humans; Iliac Vein; Phlebography; Tomography; Ultrasonography; Ultrasonography, Interventional
PubMed: 33069331
DOI: 10.1016/j.jvsv.2020.08.016 -
Journal of Vascular Surgery. Venous and... Sep 2020
Topics: Disease; Humans; Iliac Vein; Lasers; Patients; Saphenous Vein
PubMed: 32800262
DOI: 10.1016/j.jvsv.2020.03.001 -
Vascular Health and Risk Management 2019Iliac vein compression (LIVC) is a prevalent finding in the general population, but a smaller number of patients are symptomatic. ILVC should be considered in... (Review)
Review
Iliac vein compression (LIVC) is a prevalent finding in the general population, but a smaller number of patients are symptomatic. ILVC should be considered in symptomatic patients with unexplained unilateral lower leg swelling. Patients typically complain of one or more of the following symptoms: lower leg pain, heaviness, venous claudication, swelling, hyperpigmentation and ulceration. ILVC can be thrombotic, combined with acute or chronic DVT, or non-thrombotic. ILVC is best diagnosed with intravascular ultrasound (IVUS), but computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have emerged as valid screening tests. Venography underestimates the severity of ILVC but may provide insights into the anatomy and the presence of collaterals. Based on current available evidence, endovascular therapy with stenting remains the main treatment strategy for ILVC. Dedicated nitinol venous stents are currently under review by the Food and Drug Administration for potential approval in the United States. These stents have been released outside the US. There is no consensus to the optimal anticoagulation regimen post-ILVC stenting. Oral anticoagulants, however, remain a preferred therapy in patients with history of thrombotic ILVC.
Topics: Administration, Oral; Anticoagulants; Computed Tomography Angiography; Diagnostic Imaging; Endovascular Procedures; Humans; Iliac Vein; Magnetic Resonance Angiography; May-Thurner Syndrome; Phlebography; Predictive Value of Tests; Prevalence; Stents; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Interventional
PubMed: 31190849
DOI: 10.2147/VHRM.S203349 -
Vascular and Endovascular Surgery Aug 2023Spontaneous iliac vein rupture is a rare, but frequently lethal condition. It is important to timely recognize its clinical features and immediately start adequate... (Review)
Review
INTRODUCTION
Spontaneous iliac vein rupture is a rare, but frequently lethal condition. It is important to timely recognize its clinical features and immediately start adequate treatment. We aimed to increase awareness to clinical features, specific diagnostics, and treatment strategies of spontaneous iliac vein rupture by evaluating the current literature.
METHODS
A systematic search was conducted in EMBASE, Ovid MEDLINE, Cochrane, Web of Science, and Google Scholar from inception until January 23, 2023, without any restrictions. Two reviewers independently screened for eligibility and selected studies describing a spontaneous iliac vein rupture. Patient characteristics, clinical features, diagnostics, treatment strategies, and survival outcomes were collected from included studies.
RESULTS
We included 76 cases (64 studies) from the literature, mostly presenting with left-sided spontaneous iliac vein rupture (96.1%). Patients were predominantly female (84.2%), had a mean age of 61 years, and frequently presented with a concomitant deep vein thrombosis (DVT) (84.2%). After various follow-up times, 77.6% of the patients survived, either after conservative, endovascular, or open treatment. Endovenous or hybrid procedures were frequently performed if the diagnose was made before treatment, and almost all survived. Open treatment was common if the venous rupture was missed, for some cases leading to death.
CONCLUSION
Spontaneous iliac vein rupture is rare and easily missed. The diagnose should at least be considered for middle-aged and elderly females presenting with hemorrhagic shock and concomitant left-sided DVT. There are various treatment strategies for spontaneous iliac vein rupture. An early diagnose brings options for endovenous treatment, which seems to have good survival outcomes based on previously described cases.
Topics: Middle Aged; Aged; Humans; Female; Male; Venous Thrombosis; Iliac Vein; Treatment Outcome; Rupture, Spontaneous; Shock, Hemorrhagic; May-Thurner Syndrome
PubMed: 36913198
DOI: 10.1177/15385744231163707 -
Journal of Vascular Surgery Apr 2013Iliac vein stenting technology is rapidly emerging as a minimally invasive alternative to traditional open venovenous bypass procedures for iliac vein stenoses and... (Review)
Review
BACKGROUND
Iliac vein stenting technology is rapidly emerging as a minimally invasive alternative to traditional open venovenous bypass procedures for iliac vein stenoses and chronic total occlusions.
METHODS
Peer-reviewed publications meeting eligibility criteria were retrieved and reviewed from public domain databases.
RESULTS
Reviewed reports encompass ∼1500 patients. Evidence quality was judged moderate, with a grade 1B recommendation (benefits outweigh risks) for patients with disabling symptoms in whom conservative therapy had failed. A grade 2B recommendation was assigned for patients with less severe symptoms. Iliac vein stenting is safe, with negligible morbidity (<1%). Patency was 90% to 100% for nonthrombotic disease and 74% to 89% for post-thrombotic disease at 3 to 5 years. Clinical relief of pain was 86% to 94%, and relief from swelling was 66% to 89%. From 58% to 89% of venous ulcers healed. Procedural success in recanalization of chronic total occlusions was 83% to 95%. Hybrid techniques for complex cases are in evolution.
CONCLUSIONS
Iliac vein stenting is emerging as a safe and effective alternative to traditional open surgery to correct iliac vein obstruction.
Topics: Chronic Disease; Constriction, Pathologic; Diagnostic Imaging; Endovascular Procedures; Humans; Iliac Vein; Predictive Value of Tests; Severity of Illness Index; Stents; Treatment Outcome; Vascular Diseases; Vascular Patency; Vascular Surgical Procedures
PubMed: 23433816
DOI: 10.1016/j.jvs.2012.11.084 -
Journal of Vascular Surgery. Venous and... Nov 2018Venous duplex ultrasound imaging of the retroperitoneal iliac veins and vena cava has been slow to be adopted into everyday use; however, current ultrasound technology... (Review)
Review
Venous duplex ultrasound imaging of the retroperitoneal iliac veins and vena cava has been slow to be adopted into everyday use; however, current ultrasound technology allows more depth of penetration with improved image resolution. Gray-scale, color flow, and pulsed wave Doppler modalities are ideal for evaluation of the femoral-iliocaval outflow tract. Additional tools, such as chroma tint, power Doppler, and penetration harmonics, are useful for image optimization. Duplex ultrasound using the techniques described here needs to be compared and correlated with intravascular ultrasound imaging in a formal study that also looks at clinical outcomes and quality of life measures.
Topics: Blood Flow Velocity; Hemodynamics; Humans; Iliac Vein; Predictive Value of Tests; Reproducibility of Results; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex; Ultrasonography, Doppler, Pulsed; Vascular Diseases; Vena Cava, Inferior
PubMed: 30336903
DOI: 10.1016/j.jvsv.2018.06.005 -
Journal of Vascular Surgery. Venous and... Mar 2020Although correction of iliac vein stenosis is safe and efficacious, one of its major complications is iliac vein stent thrombosis. In an attempt to examine the cause of...
OBJECTIVE
Although correction of iliac vein stenosis is safe and efficacious, one of its major complications is iliac vein stent thrombosis. In an attempt to examine the cause of iliac vein stent thrombosis, we reviewed the location of underlying lesions encountered after thrombectomy or thrombolysis of iliac vein stents.
METHODS
A retrospective analysis was performed of all iliac vein venograms with intravascular ultrasound examinations at our office-based surgical center from February 2012 to July 2016. Patients included in the study had chronic venous insufficiency and failed compression therapy. All procedures were performed with local anesthesia and conscious sedation. Wallstents were used in all procedures for nonthrombotic iliac vein stenosis, ranging from 8 to 24 mm in diameter and 40 to 90 mm in length. Patients were followed with transcutaneous duplex every 3 months for the first year and every 6 to 12 months thereafter. Patients were placed on clopidogrel for 3 months or continued on their preexisting anticoagulants.
RESULTS
From February 2012 to July 2016, we performed 2228 iliac vein venograms with intravascular ultrasound examination in 1381 patients. The mean age of the patient population was 65 ±14 years (range, 21-99 years), among which 876 were female. A total of 1037 procedures were performed in the left lower extremity. Of these, 240 venograms were diagnostic. Presenting symptoms based on CEAP classification included C2 (n = 21), C3 (n = 633), C4 (n = 1065), C5 (n = 269), and C6 (n = 241). Complete thrombosis of the iliac vein stent was noted in 18 patients (0.8%) who thereafter underwent suction thrombectomy with thrombolysis. None of these patients had a prior history of deep vein thrombosis. In-stent restenosis was noted in 11 patients. Proximal lesions were found in no patients. An external iliac vein lesion was found distal to the common iliac vein stent in two patients. Common femoral vein lesions were found in six patients. These encountered lesions were then stented. All patients who underwent thrombectomy were placed on anticoagulation for 6 months. No patient were noted to suffer rethrombosis upon follow-up. No correlation with stent thrombosis was encountered for age, gender, laterality, location, presenting symptoms, or length or diameter of the stent.
CONCLUSIONS
Based on our experience, in-stent restenosis followed by inflow lesions in the common femoral vein are the most common causes of stent thrombosis. These data suggest a need for future research to target these areas.
Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Constriction, Pathologic; Endovascular Procedures; Female; Humans; Iliac Vein; Male; Middle Aged; Platelet Aggregation Inhibitors; Retrospective Studies; Risk Factors; Stents; Thrombectomy; Thrombolytic Therapy; Treatment Outcome; Vascular Diseases; Vascular Patency; Venous Thrombosis; Young Adult
PubMed: 31843484
DOI: 10.1016/j.jvsv.2019.09.017 -
Journal of Vascular Surgery. Venous and... Jan 2024The aim of this study was to investigate the prevalence of radiological left common iliac vein (LCIV) compression among the asymptomatic population and identify possible...
OBJECTIVE
The aim of this study was to investigate the prevalence of radiological left common iliac vein (LCIV) compression among the asymptomatic population and identify possible predictors.
METHODS
Contrast-enhanced abdominal and/or pelvic computed tomography scans of eligible asymptomatic patients were examined. The LCIV diameter was measured from different horizontal planes in the venous phase using PACSView. Degree of LCIV compression (D) was calculated by a predefined formula and graded as insignificant (D < 25%), mild (≥25% D < 50%), moderate (≥50% D <75%), and severe (D ≥ 75%). Venous stenosis was defined as a D of ≥50%. Comparison of variables, including gender, age, body mass index (BMI), and comorbidities was performed between the different grades of LCIV compression.
RESULTS
Between November 2019 and July 2022, 1698 eligible asymptomatic patients (53.1% females; mean age, 39.3 ± 11.8 years; mean BMI, 22.9 ± 3.6 kg/m) were reviewed. The mean D was 46.2% (range, 0.29%-90.4%). Insignificant, mild, moderate, and severe compression were distributed in 14.5%, 38.0%, 42.2%, and 5.2% of the cohort population, respectively. Prevalence of venous stenosis was higher in females than males (58.1% vs 42.2%; χ = 15.52; P < .001). Females aged ≥25 and <35 years accounted for the highest proportion of venous stenosis than other age groups and was a significant predictor (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.74-7.79; P < .001). In the Asian BMI classification group, being underweight is associated with venous stenosis (OR, 4.69; 95% CI, 2.70-8.14; P < .001) and obesity may be a protective factor (OR, 0.38; 95% CI, 0.23-0.64; P < .001). There is an inverse relationship between D and age and BMI.
CONCLUSIONS
The prevalence of radiological LCIV compression on computed tomography scans was high, but all patients were asymptomatic. Female gender, especially those aged ≥25 and <35 years, and underweight were possible predictors for venous stenosis.
Topics: Male; Humans; Female; Adult; Middle Aged; Iliac Vein; Constriction, Pathologic; Prevalence; Thinness; Vascular Diseases; May-Thurner Syndrome; Retrospective Studies
PubMed: 37572778
DOI: 10.1016/j.jvsv.2023.07.011