ABSTRACT
Ashna Raiker, Bachelors of Science
Medical Student
Renaissance School of Medicine at Stony Brook University
CENTEREACH, New York, United States
Iliac vein compression is characterized by stenosis of the left common iliac vein by the right common iliac artery due to anatomical positioning. It has a primary demographic of 20-40 year old women. Diagnostic testing is primarily morphological and conducted supine. Thus, the hemodynamic significance of nonthrombotic iliac vein obstruction is not well defined. It has come to our attention that this compression may not always be fixed. This study aims to establish the prevalence and clinical significance of position on iliac vein stenosis.
Methods:
The study included females with symptoms of the abdomen, pelvis and lower extremities relevant to pelvic vein disorders. Data was compared to an age and sex matched control group with CEAP C0-C2. VCSS, CEAP, demographic information and BMI were recorded. Examination was done with duplex ultrasound in supine position with slight torso elevation. The study was repeated with the patient standing. Significant iliac vein stenosis was defined as 50% diameter reduction. It was estimated using direct planimetric measurements. Peak vein velocity ratio of more than 2.5, inverse flow on ipsilateral internal iliac vein and presence of collaterals were also used to determine stenosis. Furthermore, luminal changes at the site of compression were recorded in detail. Many patients additionally had axial imaging, venography and IVUS in supine position and this was compared to duplex ultrasound findings.
Results:
The patient group (n=52) was young (age: 39+/-12.8 years) and lean (BMI: 24.2+/-5.3 kg/m2). The control (n=20) was similar with 34+/-11 years and a BMI of 25.8+/-5.7 kg/m2. The top signs and symptoms for patients included edema, pelvic varices, varicose veins, chronic pelvic pain, left flank pain and abdominal pain. The control group had no pelvic symptoms. Interestingly, in the patient group, 65.4% had >50% stenosis in the supine position, but only 21.2% did standing. In the control group as well 25% had a stenosis supine, but only 1.9% standing. In both cases, prevalence of a positional stenosis was noted.
Conclusions:
This study is ongoing, but preliminary data has begun to establish a prevalence of positional iliac vein stenosis. Furthermore, as this compression may not always be clinically significant, it may be an “innocent bystander” that is currently at risk of being overtreated. While a fixed stenosis will benefit from stent treatment, a positional stenosis is less likely to. Our study will help guide this decision and improve future treatment plans.