Research progress in diagnosis and treatment of iliac vein compression syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Wanhua , WANG Zhe ,  ZHAO Yu

Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding?author：

ZHAO Yu, Email: 820994765@qq.com

Keywords：

iliac vein compression syndrome; clinical manifestation; diagnosis; treatment

DOI：

10.7507/1007-9424.202208026

Video：

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Objective To investigate the research progress of diagnosis and treatment of iliac vein compression syndrome (IVCS) so as to find the optimal diagnosis and treatment method in clinic. Method Literature about etiology, pathophysiology, clinical manifestations, diagnosis and treatment of IVCS in recent years was reviewed. Results IVCS was one of the pelvic vein obstructive diseases. The compression of left common iliac vein by right common iliac artery was more common in clinic, and it could also cause partial or complete occlusion of the iliac vein due to other external pressures. Clinical manifestations mainly included venous pain, edema, varicose veins, venous ulcer, skin pigmentation, and other skin nutritional changes. The examination methods mainly included color Doppler ultrasound, computed tomography venography, magnetic resonance venography, intravascular ultrasound, and venography. The treatment method had been changed from the original open venous reconstruction to intravascular treatment. Endovascular treatment was included thrombolysis, thrombectomy, percutaneous mechanical thrombectomy, balloon angioplasty, and endovascular stent treatment or combination treatment according to whether they were combined with iliac-femoral venous thrombosis or not. Conclusion Based on the existing researches, intravascular ultrasound is the first choice to diagnose and guide the intravascular treatment, and iliac vein stenting is an effective method for the treatment of IVCS with a good long-term patency and obvious symptom improvement.

Citation： LI Wanhua, WANG Zhe, ZHAO Yu. Research progress in diagnosis and treatment of iliac vein compression syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(2): 230-235. doi: 10.7507/1007-9424.202208026 Copy

1.	Al-Otaibi M, Vaidy A, Vaidya A, et al. May-Thurner anatomy in patients with chronic thromboembolic pulmonary hypertension: an important clinical association. JACC Cardiovasc Interv, 2021, 14(17): 1940-1946.
2.	Harbin MM, Lutsey PL. May-Thurner syndrome: history of understanding and need for defining population prevalence. J Thromb Haemost, 2020, 18(3): 534-542.
3.	Cheng L, Zhao H, Zhang FX. Iliac vein compression syndrome in an asymptomatic patient population: a prospective study. Chin Med J (Engl), 2017, 130(11): 1269-1275.
4.	Corrêa MP, Kurtz GS, Bianchini L, et al. Prevalence of left iliac vein compression on computed tomography scans from a population. J Vasc Bras, 2020, 19: e20190060. doi: 10.1590/1677-5449.190060.
5.	Zhu Q, Yang L, Zhu H, et al. Prevalence of left iliac vein compression in an asymptomatic population and patients with left iliofemoral deep vein thrombosis: a multicenter cross-sectional study in southern China. Phlebology, 2022, 37(8): 602-609.
6.	Kaltenmeier CT, Erben Y, Indes J, et al. Systematic review of May-Thurner syndrome with emphasis on gender differences. J Vasc Surg Venous Lymphat Disord, 2018, 6(3): 399-407.
7.	Gupta R, Mathijs E, Hart J, et al. May-Thurner syndrome and lymphedema reconstruction. Plast Reconstr Surg Glob Open, 2022, 10(6): e4377. doi: 10.1097/GOX.0000000000004377.
8.	Mangla A, Hamad H. May-Thurner syndrome // StatPearls. Treasure Island (FL): StatPearls Publishing, 2022.
9.	Mir WAY, Shrestha DB, Aryal BB, et al. May-Thurner syndrome: an anatomic predisposition to deep vein thrombosis. Cureus, 2021, 13(7): e16682. doi: 10.7759/cureus.16682.
10.	Nasif A, Ahmed AM, Al-Embideen S, et al. Unusual presentation of right-sided May-Thurner syndrome. J Vasc Surg Cases Innov Tech, 2021, 7(4): 768-771.
11.	李嘉穎, 孫志超, 許茂盛, 等. 多層螺旋CT多平面重建髂靜脈壓迫特征和分型的研究. 中華解剖與臨床雜志, 2020, 25(2): 109-115.
12.	Vijayvergiya R, Kasinadhuni G, Sharma A, et al. Endovascular repair of a post-renal transplant internal iliac artery pseudoaneurysm. Vasc Endovascular Surg, 2021, 55(6): 651-653.
13.	Farina R, Foti PV, Pennisi I, et al. Vascular compression syndromes: a pictorial review. Ultrasonography, 2022, 41(3): 444-461.
14.	Yi JA, Hadley JB, Kuwayama DP. Atypical May-Thurner syndrome caused by endovascular aortic aneurysm repair. J Vasc Surg Cases Innov Tech, 2020, 6(3): 397-400.
15.	Moosavi J, Sadeghipour P, Mohebbi B, et al. A rare case of left inferior vena cava presenting with May-Thurner syndrome. CVIR Endovasc, 2022, 5(1): 31. doi: 10.1186/s42155-022-00305-2.
16.	Joh M, Desai KR. Treatment of nonthrombotic iliac vein lesions. Semin Intervent Radiol, 2021, 38(2): 155-159.
17.	Farina R, Foti PV, Iannace FA, et al. May Thurner syndrome: description of a case with unusual clinical onset. J Ultrasound, 2022, 25(2): 309-313.
18.	Ilaria P, Mario M, Ilaria F. Advances in vascular anatomy and pathophysiology using high resolution and multiparametric sonography. J Vasc Access, 2021, 22(1_suppl): 1-8.
19.	趙渝, 劉洪. 影像學在下肢靜脈疾病診斷中應用及其評價. 中國實用外科雜志, 2021, 41(12): 1330-1337.
20.	Radaideh Q, Patel NM, Shammas NW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag, 2019, 15: 115-122.
21.	Poyyamoli S, Mehta P, Cherian M, et al. May-Thurner syndrome. Cardiovasc Diagn Ther, 2021, 11(5): 1104-1111.
22.	Liu H, Wang J, Zhao Y, et al. Doppler ultrasound and contrast-enhanced ultrasound in detection of stent stenosis after iliac vein stenting. BMC Cardiovasc Disord, 2021, 21(1): 42. doi: 10.1186/s12872-020-01840-3.
23.	Mumoli N, Mastroiacovo D, Giorgi-Pierfranceschi M, et al. Ultrasound elastography is useful to distinguish acute and chronic deep vein thrombosis. J Thromb Haemost, 2018, 16(12): 2482-2491.
24.	Montminy ML, Thomasson JD, Tanaka GJ, et al. A comparison between intravascular ultrasound and venography in identifying key parameters essential for iliac vein stenting. J Vasc Surg Venous Lymphat Disord, 2019, 7(6): 801-807.
25.	Knuttinen MG, Naidu S, Oklu R, et al. May-Thurner: diagnosis and endovascular management. Cardiovasc Diagn Ther, 2017, 7(Suppl 3): S159-S164. doi: 10.21037/cdt.2017.10.14.
26.	Toh MR, Tang TY, Lim HHMN, et al. Review of imaging and endovascular intervention of iliocaval venous compression syndrome. World J Radiol, 2020, 12(3): 18-28.
27.	Raju S, Walker W, Noel C, et al. Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis. Vasc Med, 2021, 26(5): 549-555.
28.	Rossi FH, Kambara AM, Rodrigues TO, et al. Comparison of computed tomography venography and intravascular ultrasound in screening and classification of iliac vein obstruction in patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord, 2020, 8(3): 413-422.
29.	Shammas NW, Shammas GA, Jones-Miller S, et al. Predicting iliac vein compression with computed tomography angiography and venography: correlation with intravascular ultrasound. J Invasive Cardiol, 2018, 30(12): 452-455.
30.	Raju S, Walker W, Noel C, et al. The two-segment caliber method of diagnosing iliac vein stenosis on routine computed tomography with contrast enhancement. J Vasc Surg Venous Lymphat Disord, 2020, 8(6): 970-977.
31.	Ba?abuszek K, Toborek M, Pietura R. Comprehensive overview of the venous disorder known as pelvic congestion syndrome. Ann Med, 2022, 54(1): 22-36.
32.	Basile A, Failla G, Gozzo C. Pelvic congestion syndrome. Semin Ultrasound CT MR, 2021, 42(1): 3-12.
33.	Behzadi AH, Khilnani NM, Zhang W, et al. Pelvic cardiovascular magnetic resonance venography: venous changes with patient position and hydration status. J Cardiovasc Magn Reson, 2019, 21(1): 3. doi: 10.1186/s12968-018-0503-6.
34.	陶黎, 朱嵬, 張曉宇, 等. NCE-MRA在評價髂靜脈受壓分型中的應用價值. 血管與腔內血管外科雜志, 2022, 8(1): 17-21.
35.	Soulat G, McCarthy P, Markl M. 4D flow with MRI. Annu Rev Biomed Eng, 2020, 22: 103-126.
36.	Cheng Z, Wang H, Lin S, et al. Black-blood Venous Imaging (BBVI): a contrast-free and high-resolution magnetic resonance approach for diagnosing IVCS—a proof of concept study. Clin Appl Thromb Hemost, 2022, 28: 10760296221127275. doi: 10.1177/10760296221127275.
37.	White JM, Comerota AJ. Venous compression syndromes. Vasc Endovascular Surg, 2017, 51(3): 155-168.
38.	Saleem T, Knight A, Raju S. Diagnostic yield of intravascular ultrasound in patients with clinical signs and symptoms of lower extremity venous disease. J Vasc Surg Venous Lymphat Disord, 2020, 8(4): 634-639.
39.	Wang CM, Zhang WL, Li X. C-arm-based flat-panel detector cone-beam computed tomography venography in the diagnosis of iliac vein compression syndrome. Chin Med J (Engl), 2020, 134(4): 431-438.
40.	中國醫師協會血管外科醫師分會靜脈學組. 常見靜脈疾病診治規范(2022年版). 中華血管外科雜志, 2022, 7(1): 12-29.
41.	Roy M, Sasson M, Rosales-Velderrain A, et al. Pharmacomechanical thrombolysis for deep vein thrombosis in May-Thurner syndrome. Innovations (Phila), 2017, 12(6): 466-471.
42.	Jeon UB, Chung JW, Jae HJ, et al. May-Thurner syndrome complicated by acute iliofemoral vein thrombosis: helical CT venography for evaluation of long-term stent patency and changes in the iliac vein. AJR Am J Roentgenol, 2010, 195(3): 751-757.
43.	Oropallo A, Andersen CA. Venous stenting // StatPearls. Treasure Island (FL): StatPearls Publishing, 2022.
44.	錢愛民, 蔡志新, 張實, 等. 腔內超聲輔助下非血栓性右髂靜脈受壓綜合征的血管腔內治療. 中華醫學雜志, 2019, 99(46): 3633-3637.
45.	黃家麒, 劉曉兵, 施慧華, 等. 不同解剖類型非血栓性髂靜脈壓迫綜合征支架植入術后的療效觀察. 中國血管外科雜志(電子版), 2019, 11(3): 195-198.
46.	Sigua-Arce P, Mando R, Spencer L, et al. Treatment of May-Thurner’s syndrome and associated complications: a multicenter experience. Int J Gen Med, 2021, 14: 4705-4710.
47.	Tu LK, Nie ML, Fu J, et al. Comparing the efficacy of endovascular treatment for iliac vein compression syndrome with or without acute deep venous thrombosis: a single-center retrospective study. Vascular, 2022, 30(2): 341-348.
48.	Wasserburger J, Haponyuk A, Modhia UM, et al. Lumbosacral exostosis as a rare cause of iliac vein compression and significant limb swelling. J Vasc Surg Cases Innov Tech, 2019, 5(4): 529-531.
49.	Jost CJ, Gloviczki P, Cherry KJ, et al. Surgical reconstruction of iliofemoral veins and the inferior vena cava for nonmalignant occlusive disease. J Vasc Surg, 2001, 33(2): 320-327.

1. Al-Otaibi M, Vaidy A, Vaidya A, et al. May-Thurner anatomy in patients with chronic thromboembolic pulmonary hypertension: an important clinical association. JACC Cardiovasc Interv, 2021, 14(17): 1940-1946.
2. Harbin MM, Lutsey PL. May-Thurner syndrome: history of understanding and need for defining population prevalence. J Thromb Haemost, 2020, 18(3): 534-542.
3. Cheng L, Zhao H, Zhang FX. Iliac vein compression syndrome in an asymptomatic patient population: a prospective study. Chin Med J (Engl), 2017, 130(11): 1269-1275.
4. Corrêa MP, Kurtz GS, Bianchini L, et al. Prevalence of left iliac vein compression on computed tomography scans from a population. J Vasc Bras, 2020, 19: e20190060. doi: 10.1590/1677-5449.190060.
5. Zhu Q, Yang L, Zhu H, et al. Prevalence of left iliac vein compression in an asymptomatic population and patients with left iliofemoral deep vein thrombosis: a multicenter cross-sectional study in southern China. Phlebology, 2022, 37(8): 602-609.
6. Kaltenmeier CT, Erben Y, Indes J, et al. Systematic review of May-Thurner syndrome with emphasis on gender differences. J Vasc Surg Venous Lymphat Disord, 2018, 6(3): 399-407.
7. Gupta R, Mathijs E, Hart J, et al. May-Thurner syndrome and lymphedema reconstruction. Plast Reconstr Surg Glob Open, 2022, 10(6): e4377. doi: 10.1097/GOX.0000000000004377.
8. Mangla A, Hamad H. May-Thurner syndrome // StatPearls. Treasure Island (FL): StatPearls Publishing, 2022.
9. Mir WAY, Shrestha DB, Aryal BB, et al. May-Thurner syndrome: an anatomic predisposition to deep vein thrombosis. Cureus, 2021, 13(7): e16682. doi: 10.7759/cureus.16682.
10. Nasif A, Ahmed AM, Al-Embideen S, et al. Unusual presentation of right-sided May-Thurner syndrome. J Vasc Surg Cases Innov Tech, 2021, 7(4): 768-771.
11. 李嘉穎, 孫志超, 許茂盛, 等. 多層螺旋CT多平面重建髂靜脈壓迫特征和分型的研究. 中華解剖與臨床雜志, 2020, 25(2): 109-115.
12. Vijayvergiya R, Kasinadhuni G, Sharma A, et al. Endovascular repair of a post-renal transplant internal iliac artery pseudoaneurysm. Vasc Endovascular Surg, 2021, 55(6): 651-653.
13. Farina R, Foti PV, Pennisi I, et al. Vascular compression syndromes: a pictorial review. Ultrasonography, 2022, 41(3): 444-461.
14. Yi JA, Hadley JB, Kuwayama DP. Atypical May-Thurner syndrome caused by endovascular aortic aneurysm repair. J Vasc Surg Cases Innov Tech, 2020, 6(3): 397-400.
15. Moosavi J, Sadeghipour P, Mohebbi B, et al. A rare case of left inferior vena cava presenting with May-Thurner syndrome. CVIR Endovasc, 2022, 5(1): 31. doi: 10.1186/s42155-022-00305-2.
16. Joh M, Desai KR. Treatment of nonthrombotic iliac vein lesions. Semin Intervent Radiol, 2021, 38(2): 155-159.
17. Farina R, Foti PV, Iannace FA, et al. May Thurner syndrome: description of a case with unusual clinical onset. J Ultrasound, 2022, 25(2): 309-313.
18. Ilaria P, Mario M, Ilaria F. Advances in vascular anatomy and pathophysiology using high resolution and multiparametric sonography. J Vasc Access, 2021, 22(1_suppl): 1-8.
19. 趙渝, 劉洪. 影像學在下肢靜脈疾病診斷中應用及其評價. 中國實用外科雜志, 2021, 41(12): 1330-1337.
20. Radaideh Q, Patel NM, Shammas NW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag, 2019, 15: 115-122.
21. Poyyamoli S, Mehta P, Cherian M, et al. May-Thurner syndrome. Cardiovasc Diagn Ther, 2021, 11(5): 1104-1111.
22. Liu H, Wang J, Zhao Y, et al. Doppler ultrasound and contrast-enhanced ultrasound in detection of stent stenosis after iliac vein stenting. BMC Cardiovasc Disord, 2021, 21(1): 42. doi: 10.1186/s12872-020-01840-3.
23. Mumoli N, Mastroiacovo D, Giorgi-Pierfranceschi M, et al. Ultrasound elastography is useful to distinguish acute and chronic deep vein thrombosis. J Thromb Haemost, 2018, 16(12): 2482-2491.
24. Montminy ML, Thomasson JD, Tanaka GJ, et al. A comparison between intravascular ultrasound and venography in identifying key parameters essential for iliac vein stenting. J Vasc Surg Venous Lymphat Disord, 2019, 7(6): 801-807.
25. Knuttinen MG, Naidu S, Oklu R, et al. May-Thurner: diagnosis and endovascular management. Cardiovasc Diagn Ther, 2017, 7(Suppl 3): S159-S164. doi: 10.21037/cdt.2017.10.14.
26. Toh MR, Tang TY, Lim HHMN, et al. Review of imaging and endovascular intervention of iliocaval venous compression syndrome. World J Radiol, 2020, 12(3): 18-28.
27. Raju S, Walker W, Noel C, et al. Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis. Vasc Med, 2021, 26(5): 549-555.
28. Rossi FH, Kambara AM, Rodrigues TO, et al. Comparison of computed tomography venography and intravascular ultrasound in screening and classification of iliac vein obstruction in patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord, 2020, 8(3): 413-422.
29. Shammas NW, Shammas GA, Jones-Miller S, et al. Predicting iliac vein compression with computed tomography angiography and venography: correlation with intravascular ultrasound. J Invasive Cardiol, 2018, 30(12): 452-455.
30. Raju S, Walker W, Noel C, et al. The two-segment caliber method of diagnosing iliac vein stenosis on routine computed tomography with contrast enhancement. J Vasc Surg Venous Lymphat Disord, 2020, 8(6): 970-977.
31. Ba?abuszek K, Toborek M, Pietura R. Comprehensive overview of the venous disorder known as pelvic congestion syndrome. Ann Med, 2022, 54(1): 22-36.
32. Basile A, Failla G, Gozzo C. Pelvic congestion syndrome. Semin Ultrasound CT MR, 2021, 42(1): 3-12.
33. Behzadi AH, Khilnani NM, Zhang W, et al. Pelvic cardiovascular magnetic resonance venography: venous changes with patient position and hydration status. J Cardiovasc Magn Reson, 2019, 21(1): 3. doi: 10.1186/s12968-018-0503-6.
34. 陶黎, 朱嵬, 張曉宇, 等. NCE-MRA在評價髂靜脈受壓分型中的應用價值. 血管與腔內血管外科雜志, 2022, 8(1): 17-21.
35. Soulat G, McCarthy P, Markl M. 4D flow with MRI. Annu Rev Biomed Eng, 2020, 22: 103-126.
36. Cheng Z, Wang H, Lin S, et al. Black-blood Venous Imaging (BBVI): a contrast-free and high-resolution magnetic resonance approach for diagnosing IVCS—a proof of concept study. Clin Appl Thromb Hemost, 2022, 28: 10760296221127275. doi: 10.1177/10760296221127275.
37. White JM, Comerota AJ. Venous compression syndromes. Vasc Endovascular Surg, 2017, 51(3): 155-168.
38. Saleem T, Knight A, Raju S. Diagnostic yield of intravascular ultrasound in patients with clinical signs and symptoms of lower extremity venous disease. J Vasc Surg Venous Lymphat Disord, 2020, 8(4): 634-639.
39. Wang CM, Zhang WL, Li X. C-arm-based flat-panel detector cone-beam computed tomography venography in the diagnosis of iliac vein compression syndrome. Chin Med J (Engl), 2020, 134(4): 431-438.
40. 中國醫師協會血管外科醫師分會靜脈學組. 常見靜脈疾病診治規范(2022年版). 中華血管外科雜志, 2022, 7(1): 12-29.
41. Roy M, Sasson M, Rosales-Velderrain A, et al. Pharmacomechanical thrombolysis for deep vein thrombosis in May-Thurner syndrome. Innovations (Phila), 2017, 12(6): 466-471.
42. Jeon UB, Chung JW, Jae HJ, et al. May-Thurner syndrome complicated by acute iliofemoral vein thrombosis: helical CT venography for evaluation of long-term stent patency and changes in the iliac vein. AJR Am J Roentgenol, 2010, 195(3): 751-757.
43. Oropallo A, Andersen CA. Venous stenting // StatPearls. Treasure Island (FL): StatPearls Publishing, 2022.
44. 錢愛民, 蔡志新, 張實, 等. 腔內超聲輔助下非血栓性右髂靜脈受壓綜合征的血管腔內治療. 中華醫學雜志, 2019, 99(46): 3633-3637.
45. 黃家麒, 劉曉兵, 施慧華, 等. 不同解剖類型非血栓性髂靜脈壓迫綜合征支架植入術后的療效觀察. 中國血管外科雜志(電子版), 2019, 11(3): 195-198.
46. Sigua-Arce P, Mando R, Spencer L, et al. Treatment of May-Thurner’s syndrome and associated complications: a multicenter experience. Int J Gen Med, 2021, 14: 4705-4710.
47. Tu LK, Nie ML, Fu J, et al. Comparing the efficacy of endovascular treatment for iliac vein compression syndrome with or without acute deep venous thrombosis: a single-center retrospective study. Vascular, 2022, 30(2): 341-348.
48. Wasserburger J, Haponyuk A, Modhia UM, et al. Lumbosacral exostosis as a rare cause of iliac vein compression and significant limb swelling. J Vasc Surg Cases Innov Tech, 2019, 5(4): 529-531.
49. Jost CJ, Gloviczki P, Cherry KJ, et al. Surgical reconstruction of iliofemoral veins and the inferior vena cava for nonmalignant occlusive disease. J Vasc Surg, 2001, 33(2): 320-327.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress in diagnosis and treatment of iliac vein compression syndrome

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