Korean J Radiol.  2009 Apr;10(2):135-143. 10.3348/kjr.2009.10.2.135.

Endovascular Treatment for Iliac Vein Compression Syndrome: a Comparison between the Presence and Absence of Secondary Thrombosis

• Lou WS
• Gu JP
• He X
• Chen L
• Su HB
• Chen GP
• Song JH
• Wang T

• KMID: 1088724
• DOI: http://doi.org/10.3348/kjr.2009.10.2.135

Abstract

OBJECTIVE
To evaluate the value of early identification and endovascular treatment of iliac vein compression syndrome (IVCS), with or without deep vein thrombosis (DVT).
MATERIALS AND METHODS
Three groups of patients, IVCS without DVT (group 1, n = 39), IVCS with fresh thrombosis (group 2, n = 52) and IVCS with non-fresh thrombosis (group 3, n = 34) were detected by Doppler ultrasonography, magnetic resonance venography, computed tomography or venography. The fresh venous thrombosis were treated by aspiration and thrombectomy, whereas the iliac vein compression per se were treated with a self-expandable stent. In cases with fresh thrombus, the inferior vena cava filter was inserted before the thrombosis suction, mechanical thrombus ablation, percutaneous transluminal angioplasty, stenting or transcatheter thrombolysis.
RESULTS
Stenting was performed in 111 patients (38 of 39 group 1 patients and 73 of 86 group 2 or 3 patients). The stenting was tried in one of group 1 and in three of group 2 or 3 patients only to fail. The initial patency rates were 95% (group 1), 89% (group 2) and 65% (group 3), respectively and were significantly different (p = 0.001). Further, the six month patency rates were 93% (group 1), 83% (group 2) and 50% (group 3), respectively, and were similarly significantly different (p = 0.001). Both the initial and six month patency rates in the IVCS patients (without thrombosis or with fresh thrombosis), were significantly greater than the patency rates of IVCS patients with non-fresh thrombosis.
CONCLUSION
From the cases examined, the study suggests that endovascular treatment of IVCS, with or without thrombosis, is effective.

Keyword

Iliac vein compression syndrome; Deep vein thrombosis; Therapy, Interventional

MeSH Terms

Adolescent
Adult
Aged
*Angioplasty, Balloon
*Balloon Dilatation
Constriction, Pathologic/therapy
Diagnostic Imaging
Female
Humans
Iliac Vein/*pathology/surgery
Male
Middle Aged
Peripheral Vascular Diseases/complications/diagnosis/*therapy
Retrospective Studies
*Stents
Thrombectomy
Vascular Patency
Vena Cava Filters
Venous Thrombosis/complications/diagnosis/*therapy

Figure

• 

  Fig. 1 Treatment of iliac vein compression syndrome without deep vein thrombosis. A. Venography showing compressed left common iliac vein (black arrow) and contralateral venous drainage via pelvic venous collaterals (white arrow). B. Venography after stenting showing widely patent left common iliac vein.

• 

  Fig. 2 Treatment of iliac vein compression syndrome with deep vein thrombosis. A. Venography showing thrombosis (fresh thrombus and 8 days after onset) and occlusion of left iliofemoral vein as well as contralateral venous drainage via pelvic venous collaterals. B. Venography after thrombectomy and stenting showing patent left femoral vein and in-stent stenosis due to iliac vein compression (black arrow). C. Venography after intra-stent percutaneous transluminal angioplasty showing widely patent left common iliac vein. D. Venography one year after retrieval of filter showing remaining patent inferior vena cava and left iliofemoral vein.

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