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Semin intervent Radiol 2021; 38(02): 155-159
DOI: 10.1055/s-0041-1727101
Review Article

Treatment of Nonthrombotic Iliac Vein Lesions

Maria Joh
1   Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
,
Kush R. Desai
1   Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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Abstract

Nonthrombotic iliac vein lesions (NIVLs) most frequently result from extrinsic compression of various segments of the common or external iliac vein. Patients develop symptoms associated with chronic venous insufficiency (CVI); female patients may develop symptoms of pelvic venous disease. Given that iliac vein compression can be clinically silent, a thorough history and physical examination is mandatory to exclude other causes of a patient's symptoms. Venous duplex ultrasound, insufficiency examinations, and axial imaging are most commonly used to assess for the presence of a NIVL. Catheter venography and intravascular ultrasound (IVUS) are the mainstay for invasive assessment of NIVLs and planning prior to stent placement. IVUS in particular has become the primary modality by which NIVLs are evaluated; recent evidence has clarified the lesion threshold for stent placement, which is indicated in patients with moderate to severe symptoms. In appropriately selected patients, stent placement results in improved pain, swelling, quality of life, and, when present, healing of venous stasis ulcers. Stent patency is well preserved in the majority of cases, with a low incidence of clinically driven need for reintervention. In this article, we will discuss the clinical features, workup, endovascular management, and treatment outcomes of NIVL.

Keywords

iliac vein compression - May–Thurner syndrome - chronic venous insufficiency - venous stents - interventional radiology


Publikationsverlauf

Artikel online veröffentlicht:
03. Juni 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005; 15 (03) 175-184
    CrossrefPubMedGoogle Scholar
  • 2 Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation 2014; 130 (04) 333-346
    CrossrefPubMedGoogle Scholar
  • 3 Chiesa R, Marone EM, Limoni C, Volonté M, Schaefer E, Petrini O. Effect of chronic venous insufficiency on activities of daily living and quality of life: correlation of demographic factors with duplex ultrasonography findings. Angiology 2007; 58 (04) 440-449
    CrossrefPubMedGoogle Scholar
  • 4 Tsai S, Dubovoy A, Wainess R, Upchurch Jr GR, Wakefield TW, Henke PK. Severe chronic venous insufficiency: magnitude of the problem and consequences. Ann Vasc Surg 2005; 19 (05) 705-711
    CrossrefPubMedGoogle Scholar
  • 5 McMurrich JP. The occurrence of congenital adhesions in the common iliac veins, and their relation to thrombosis of the femoral and iliac veins. Am J Med Sci 1908; 135 (03) 342-346
    CrossrefPubMedGoogle Scholar
  • 6 Ehrich WE, Krumbhaar EB. A frequent obstructive anomaly of the mouth of the left common iliac vein. Am Heart J 1943; 26 (06) 18-31
    CrossrefPubMedGoogle Scholar
  • 7 May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology 1957; 8 (05) 419-427
    CrossrefPubMedGoogle Scholar
  • 8 Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg 1965; 52 (10) 816-821
    CrossrefPubMedGoogle Scholar
  • 9 Cockett FB, Thomas ML, Negus D. Iliac vein compression--its relation to iliofemoral thrombosis and the post-thrombotic syndrome. BMJ 1967; 2 (5543): 14-19
    CrossrefPubMedGoogle Scholar
  • 10 Raju S. Best management options for chronic iliac vein stenosis and occlusion. J Vasc Surg 2013; 57 (04) 1163-1169
    CrossrefPubMedGoogle Scholar
  • 11 Mahnken AH, Thomson K, de Haan M, O'Sullivan GJ. CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Intervent Radiol 2014; 37 (04) 889-897
    PubMedGoogle Scholar
  • 12 Neglén P, Hollis KC, Olivier J, Raju S. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg 2007; 46 (05) 979-990
    CrossrefPubMedGoogle Scholar
  • 13 Kibbe MR, Ujiki M, Goodwin AL, Eskandari M, Yao J, Matsumura J. Iliac vein compression in an asymptomatic patient population. J Vasc Surg 2004; 39 (05) 937-943
    CrossrefPubMedGoogle Scholar
  • 14 Oguzkurt L, Ozkan U, Ulusan S, Koc Z, Tercan F. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol 2008; 19 (03) 366-370 , quiz 371
    CrossrefPubMedGoogle Scholar
  • 15 Raju S, Neglen P. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg 2006; 44 (01) 136-143 , discussion 144
    CrossrefPubMedGoogle Scholar
  • 16 Lurie F, Passman M, Meisner M. et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord 2020; 8 (03) 342-352
    CrossrefPubMedGoogle Scholar
  • 17 Marston WA, Vasquez MA, Lurie F. et al; American Venous Forum Outcomes Working Group. Multicenter assessment of the repeatability and reproducibility of the revised Venous Clinical Severity Score (rVCSS). J Vasc Surg Venous Lymphat Disord 2013; 1 (03) 219-224
    CrossrefPubMedGoogle Scholar
  • 18 Vasquez MA, Rabe E, McLafferty RB. et al; American Venous Forum Ad Hoc Outcomes Working Group. 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 (05) 1387-1396
    CrossrefPubMedGoogle Scholar
  • 19 Goldman RE, Arendt VA, Kothary N. et al. Endovascular management of May-Thurner syndrome in adolescents: a single-center experience. J Vasc Interv Radiol 2017; 28 (01) 71-77
    CrossrefPubMedGoogle Scholar
  • 20 Stuck AK, Reich T, Engelberger RP, Sebastian T, Kucher N. Endovascular treatment of post-thrombotic and non-thrombotic iliofemoral venous outflow obstructions with self-expanding nitinol stents. Vasa 2018; 47 (04) 319-325
    CrossrefPubMedGoogle Scholar
  • 21 Soosainathan A, Moore HM, Gohel MS, Davies AH. Scoring systems for the post-thrombotic syndrome. J Vasc Surg 2013; 57 (01) 254-261
    CrossrefPubMedGoogle Scholar
  • 22 Hui JZ, Goldman RE, Mabud TS, Arendt VA, Kuo WT, Hofmann LV. Diagnostic performance of lower extremity Doppler ultrasound in detecting iliocaval obstruction. J Vasc Surg Venous Lymphat Disord 2020; 8 (05) 821-830
    CrossrefPubMedGoogle Scholar
  • 23 Sloves J, Almeida JI. Venous duplex ultrasound protocol for iliocaval disease. J Vasc Surg Venous Lymphat Disord 2018; 6 (06) 748-757
    CrossrefPubMedGoogle Scholar
  • 24 Jain AK, Soult MC, Resnick SA. et al. Detecting iliac vein thrombosis with current protocols of lower extremity venous duplex ultrasound. J Vasc Surg Venous Lymphat Disord 2018; 6 (06) 724-729
    CrossrefPubMedGoogle Scholar
  • 25 Metzger PB, Rossi FH, Kambara AM. et al. Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound. J Vasc Surg Venous Lymphat Disord 2016; 4 (01) 18-27
    CrossrefPubMedGoogle Scholar
  • 26 Khilnani NM. Duplex ultrasound evaluation of patients with chronic venous disease of the lower extremities. AJR Am J Roentgenol 2014; 202 (03) 633-642
    CrossrefPubMedGoogle Scholar
  • 27 Toh MR, Tang TY, Lim HHMN, Venkatanarasimha N, Damodharan K. Review of imaging and endovascular intervention of iliocaval venous compression syndrome. World J Radiol 2020; 12 (03) 18-28
    CrossrefPubMedGoogle Scholar
  • 28 Forauer AR, Gemmete JJ, Dasika NL, Cho KJ, Williams DM. Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol 2002; 13 (05) 523-527
    CrossrefPubMedGoogle Scholar
  • 29 Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg 2002; 35 (04) 694-700
    CrossrefPubMedGoogle Scholar
  • 30 Hurst DR, Forauer AR, Bloom JR, Greenfield LJ, Wakefield TW, Williams DM. Diagnosis and endovascular treatment of iliocaval compression syndrome. J Vasc Surg 2001; 34 (01) 106-113
    CrossrefPubMedGoogle Scholar
  • 31 Raju S, Martin A, Davis M. The importance of IVUS assessment in venous thrombolytic regimens. J Vasc Surg Venous Lymphat Disord 2013; 1 (01) 108
    CrossrefPubMedGoogle Scholar
  • 32 Gagne PJ, Tahara RW, Fastabend CP. et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord 2017; 5 (05) 678-687
    CrossrefPubMedGoogle Scholar
  • 33 Gagne PJ, Gasparis A, Black S. et al. Analysis of threshold stenosis by multiplanar venogram and intravascular ultrasound examination for predicting clinical improvement after iliofemoral vein stenting in the VIDIO trial. J Vasc Surg Venous Lymphat Disord 2018; 6 (01) 48-56.e1
    CrossrefPubMedGoogle Scholar
  • 34 Chen F, Den J, Yuan QW, Zhou WM, Xiong JX, Zhou W. Compression of left common iliac vein is independently associated with left-sided deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2013; 1 (04) 364-369
    CrossrefPubMedGoogle Scholar
  • 35 Birn J, Vedantham S. May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med 2015; 20 (01) 74-83
    CrossrefPubMedGoogle Scholar
  • 36 Chan KT, Tye GA, Popat RA. et al. Common iliac vein stenosis: a risk factor for oral contraceptive-induced deep vein thrombosis. Am J Obstet Gynecol 2011; 205 (06) 537.e1-537.e6
    CrossrefPubMedGoogle Scholar
  • 37 Carr S, Chan K, Rosenberg J. et al. Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis. J Vasc Interv Radiol 2012; 23 (11) 1467-1472
    CrossrefPubMedGoogle Scholar
  • 38 Raju S. Treatment of iliac-caval outflow obstruction. Semin Vasc Surg 2015; 28 (01) 47-53
    CrossrefPubMedGoogle Scholar
  • 39 Razavi MK, Black S, Gagne P, Chiacchierini R, Nicolini P, Marston W. VIRTUS Investigators. Pivotal study of endovenous stent placement for symptomatic iliofemoral venous obstruction. Circ Cardiovasc Interv 2019; 12 (12) e008268
    CrossrefPubMedGoogle Scholar
  • 40 Raju S, Tackett Jr P, Neglen P. Reinterventions for nonocclusive iliofemoral venous stent malfunctions. J Vasc Surg 2009; 49 (02) 511-518
    CrossrefPubMedGoogle Scholar
  • 41 Tran MA, Lakhanpal P, Lakhanpal S, Satwah VK, Lakhanpal G, Pappas PJ. Type of anti-thrombotic therapy for venous stenting in patients with non-thrombotic iliac vein lesions does not influence the development of in-stent restenosis. Phlebology 2020; 35 (10) 805-813
    CrossrefPubMedGoogle Scholar
  • 42 Yin M, Huang X, Cui C. et al. The effect of stent placement for May-Thurner syndrome combined with symptomatic superficial venous reflux disease. J Vasc Surg Venous Lymphat Disord 2015; 3 (02) 168-172
    CrossrefPubMedGoogle Scholar
  • 43 Ye K, Lu X, Li W. et al. Long-term outcomes of stent placement for symptomatic nonthrombotic iliac vein compression lesions in chronic venous disease. J Vasc Interv Radiol 2012; 23 (04) 497-502
    CrossrefPubMedGoogle Scholar
  • 44 Raju S, Darcey R, Neglén P. Unexpected major role for venous stenting in deep reflux disease. J Vasc Surg 2010; 51 (02) 401-408 , discussion 408
    CrossrefPubMedGoogle Scholar
  • 45 Liu Z, Gao N, Shen L. et al. Endovascular treatment for symptomatic iliac vein compression syndrome: a prospective consecutive series of 48 patients. Ann Vasc Surg 2014; 28 (03) 695-704
    CrossrefPubMedGoogle Scholar
  • 46 Raju S, Kirk OK, Jones TL. Endovenous management of venous leg ulcers. J Vasc Surg Venous Lymphat Disord 2013; 1 (02) 165-172
    CrossrefPubMedGoogle Scholar
  • 47 Raju S, Owen Jr S, Neglen P. The clinical impact of iliac venous stents in the management of chronic venous insufficiency. J Vasc Surg 2002; 35 (01) 8-15
    CrossrefPubMedGoogle Scholar
  • 48 Razavi MK, Jaff MR, Miller LE. Safety and effectiveness of stent placement for iliofemoral venous outflow obstruction: systematic review and meta-analysis. Circ Cardiovasc Interv 2015; 8 (10) e002772
    CrossrefPubMedGoogle Scholar
  • 49 Wen-da W, Yu Z, Yue-Xin C. Stenting for chronic obstructive venous disease: a current comprehensive meta-analysis and systematic review. Phlebology 2016; 31 (06) 376-389
    CrossrefPubMedGoogle Scholar
  • 50 Khairy SA, Neves RJ, Hartung O, O'Sullivan GJ. Factors associated with contralateral deep venous thrombosis after iliocaval venous stenting. Eur J Vasc Endovasc Surg 2017; 54 (06) 745-751
    CrossrefPubMedGoogle Scholar
  • 51 Gloviczki P, Lawrence PF. Iliac vein stenting and contralateral deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2017; 5 (01) 5-6
    CrossrefPubMedGoogle Scholar