Impact of concurrent iliac vein compression relief on surgical outcomes for great saphenous vein varicosities: A propensity score-matched study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GAN Mao ^1,2 , ZHANG Wei ^1,2 , WANG Zhe ^1,2 , HE Linxiang ^1,2 , YE Xiaoping ³ , ZHAO Yu ^1,2 ,  LIU Hong ^1,2

1. Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;
2. Day Surgery Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;
3. Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding?author：

LIU Hong, Email: liuhong6261@163.com

Keywords：

iliac vein compression; lower extremity varicose vein; endovascular treatment; propensity score-matching

DOI：

10.7507/1007-9424.202504015

Video：

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Objective To compare the efficacy of varicose great saphenous vein (GSV) treatment alone versus combined treatment with iliac vein compression (IVC) intervention in improving lower extremity symptoms and prognosis among the patients with varicose GSV complicated by IVC. Methods Based on inclusion and exclusion criteria, the patients with varicose GSV complicated by IVC treated at the Day Service Center of the First Affiliated Hospital of Chongqing Medical University from May 2022 to January 2025 were retrospectively enrolled. The patients were assigned into two groups according to the treatment strategies: the varicose GSV treatment alone group (control group) and the combined treatment group for varicose GSV and IVC (observation group). The primary endpoints included the closure rate of the GSV trunk, venous clinical severity score (VCSS), and venous insufficiency epidemiological and economic study quality of life/symptom (VEINES-QOL/Sym) questionnaire score at 6 and 12 months postoperatively. The significance level was set at α=0.05. Results A total of 264 patients with left lower extremity varicose GSV complicated by IVC were included. The observation group comprised 32 patients, while the remaining 232 patients underwent 1∶3 propensity score-matching, resulting in 96 matched patients in the control group. The baseline characteristics, including gender, age, and comorbidities, showed no statistically significant differences between the two groups (P>0.05). At 12 months postoperatively, the GSV trunk closure rate was 100% in both groups. Within-group comparisons revealed significant improvements in the VCSS and VEINES-QOL/Sym points at 6 and 12 months as compared with preoperative (on admission) values (P<0.05). Between-group comparisons showed that the observation group had greater improvement in the VEINES-QOL/Sym score at 6 months (P=0.028), but no significant difference in the VCSS (P=0.775); At 12 months, the observation group demonstrated significantly better the VCSS (P<0.001) and VEINES-QOL/Sym points (P<0.001) as compared with the control group. Conclusions For patients with left lower extremity GSV varicosities complicated by IVC, both treatment strategies significantly improve symptoms. Results of short-term follow-up (6 months) demonstrate early advantages in quality of life improvement with concurrent IVC intervention, while results of 12-month follow-up indicate superior efficacy in both symptom relief and quality of life enhancement. Therefore, concurrent IVC intervention may provide greater clinical benefits for mid- to long-term prognosis for patients with left lower extremity GSV varicosities complicated by IVC.

Citation： GAN Mao, ZHANG Wei, WANG Zhe, HE Linxiang, YE Xiaoping, ZHAO Yu, LIU Hong. Impact of concurrent iliac vein compression relief on surgical outcomes for great saphenous vein varicosities: A propensity score-matched study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(4): 422-427. doi: 10.7507/1007-9424.202504015 Copy

1.	Balint R, Farics A, Parti K, et al. Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review. Vascular, 2016, 24(6): 649-657.
2.	中華醫學會外科學分會血管外科學組, 中國醫師協會血管外科醫師分會, 中國醫療保健國際交流促進會血管外科分會, 等. 中國慢性靜脈疾病診斷與治療指南. 中華醫學雜志, 2019, 99(39): 3047-3061.
3.	Radaideh Q, Patel NM, Shammas NW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag, 2019, 15: 115-122.
4.	李振振, 肖占祥, 李灼日, 等. Cockett綜合征誘發下肢深靜脈血栓形成的腔內治療: 附27例報告. 中國普通外科雜志, 2016, 25(9): 1346-1350.
5.	Kingdon J, Gwozdz AM, Morris R, et al. Device profile of the Vici venous stent for chronic iliofemoral venous obstruction recanalization: overview of its safety and efficacy. Expert Rev Med Devices, 2020, 17(5): 391-397.
6.	Ziporin SJ, Ifune CK, MacConmara MP, et al. A case of external iliac arteriovenous fistula and high-output cardiac failure after endovenous laser treatment of great saphenous vein. J Vasc Surg, 2010, 51(3): 715-719.
7.	Rass K, Frings N, Glowacki P, et al. Same site recurrence is more frequent after endovenous laser ablation compared with high ligation and stripping of the great saphenous vein: 5 year results of a randomized clinical trial (RELACS study). Eur J Vasc Endovasc Surg, 2015, 50(5): 648-656.
8.	徐萌, 王海南, 韓雙喜. 大隱靜脈曲張手術治療的研究進展. 中國醫藥指南, 2025, 23(8): 35-37.
9.	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(1): 136-143.
10.	Costa LMG, Tachibana A, Magao FDS, et al. Magnetic resonanceimaging evaluation of left common iliac vein compression in patients with and without symptoms of venous disease. Circ J, 2020, 84(5): 763-768.
11.	Cavalcante LP, Souza, JEDS,Pereira R,et al.Iliac vein compression syndrome: literature review. J Vasc Bras, 2015, 14(1): 78-83.
12.	Fereydooni A, Stern JR. Contemporary treatment of May-Thurner Syndrome. J Cardiovasc Surg (Torino), 2021, 62(5): 447-455.
13.	Yang S, Zhao J, Hou P, et al. Effect of balloon dilatation and stent implantation in iliac vein compression syndrome. Thorac Cardiovasc Surg, 2025 Feb 14. doi: 10.1055/a-2496-5378.
14.	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.
15.	魏強, 王雅潔, 高玉海, 等. 不同介入方法治療急性髂股靜脈血栓合并髂靜脈壓迫綜合征療效比較. 浙江臨床醫學, 2023, 25(7): 1048-1050.
16.	Guo Z, Li X, Wang T, et al. Effectiveness of iliac vein stenting combined with high ligation/endovenous laser treatment of the great saphenous veins in patients with Clinical, Etiology, Anatomy, Pathophysiology class 4 to 6 chronic venous disease. J Vasc Surg Venous Lymphat Disord, 2020, 8(1): 74-83.
17.	Kong J, Liu P, Li J, et al. Surgical treatment of recurrent varicose veins in the lower limbs associated with endovascular treatment of iliac vein stenosis. Int J Surg, 2018, 50: 110-113.
18.	Raju S, Lucas M, Luke C, et al. Long-term improvement of limb reflux prevalence and severity after iliac vein stent placement. J Vasc Surg Venous Lymphat Disord, 2022, 10(3): 640-645.
19.	Sawafta K, Yousef F, Hijleh HA, et al. May-Thurner syndrome as an underlying cause of unilateral left-sided deep vein thrombosis in a young healthy female: A case report. Radiol Case Rep, 2025, 20(3): 1740-1744.
20.	Zheng B, Liu G, Liu Y. Ultrasound characteristics and risk factors of female patients with pelvic varicose veins and concomitant chronic pelvic pain. J Vasc Surg Venous Lymphat Disord, 2025, 13(2): 102165. doi: 10.1016/j.jvsv.2024.102165.
21.	Joh M, Desai KR. Treatment of nonthrombotic iliac vein lesions. Semin Intervent Radiol, 2021, 38(2): 155-159.
22.	中國微循環學會周圍血管疾病專業委員會. 原發性下肢淺靜脈曲張診治專家共識(2021版). 血管與腔內血管外科雜志, 2021, 7(7): 762-772.
23.	Stevens SM, Woller SC, Baumann Kreuziger L, et al. Executive summary: Antithrombotic therapy for VTE disease: Second update of the CHEST guideline and expert panel report. Chest, 2021, 160(6): 2247-2259.
24.	Baccellieri D, Ardita V, Pannone A, et al. Factors influencing recurrent varicose vein formation after radiofrequency thermal ablation for truncal reflux performed in two high-volume venous centers. J Vasc Surg Venous Lymphat Disord, 2024, 12(2): 101675. doi: 10.1016/j.jvsv.2023.08.014.
25.	黎萬華, 王哲, 趙渝. 髂靜脈壓迫綜合征診療的研究進展. 中國普外基礎與臨床雜志, 2023, 30(2): 230-235.
26.	趙新宇, 陳世遠. 髂靜脈壓迫綜合征診療進展. 中華普通外科學文獻(電子版), 2021, 15(3): 229-233.
27.	Bashar K, Shalan A, Sharafat Ali S, et al. Endovascular versus medical treatment of venous compression syndrome of the iliac vein— A systematic review. Vasa, 2021, 50(1): 22-29.
28.	Rohlffs F, Spanos K, Debus ES, et al. Modern image acquisition system reduces radiation exposure to patients and staff during complex endovascular aortic repair. Eur J Vasc Endovasc Surg, 2020, 59(2): 295-300.
29.	Haufe FL, Wolf P, Riener R, et al. Biomechanical effects of passive hip springs during walking. J Biomech, 2020, 98: 109432. doi: 10.1016/j.jbiomech.2019.109432.
30.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 2016, 149(2): 315-352.

1. Balint R, Farics A, Parti K, et al. Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review. Vascular, 2016, 24(6): 649-657.
2. 中華醫學會外科學分會血管外科學組, 中國醫師協會血管外科醫師分會, 中國醫療保健國際交流促進會血管外科分會, 等. 中國慢性靜脈疾病診斷與治療指南. 中華醫學雜志, 2019, 99(39): 3047-3061.
3. Radaideh Q, Patel NM, Shammas NW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag, 2019, 15: 115-122.
4. 李振振, 肖占祥, 李灼日, 等. Cockett綜合征誘發下肢深靜脈血栓形成的腔內治療: 附27例報告. 中國普通外科雜志, 2016, 25(9): 1346-1350.
5. Kingdon J, Gwozdz AM, Morris R, et al. Device profile of the Vici venous stent for chronic iliofemoral venous obstruction recanalization: overview of its safety and efficacy. Expert Rev Med Devices, 2020, 17(5): 391-397.
6. Ziporin SJ, Ifune CK, MacConmara MP, et al. A case of external iliac arteriovenous fistula and high-output cardiac failure after endovenous laser treatment of great saphenous vein. J Vasc Surg, 2010, 51(3): 715-719.
7. Rass K, Frings N, Glowacki P, et al. Same site recurrence is more frequent after endovenous laser ablation compared with high ligation and stripping of the great saphenous vein: 5 year results of a randomized clinical trial (RELACS study). Eur J Vasc Endovasc Surg, 2015, 50(5): 648-656.
8. 徐萌, 王海南, 韓雙喜. 大隱靜脈曲張手術治療的研究進展. 中國醫藥指南, 2025, 23(8): 35-37.
9. 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(1): 136-143.
10. Costa LMG, Tachibana A, Magao FDS, et al. Magnetic resonanceimaging evaluation of left common iliac vein compression in patients with and without symptoms of venous disease. Circ J, 2020, 84(5): 763-768.
11. Cavalcante LP, Souza, JEDS,Pereira R,et al.Iliac vein compression syndrome: literature review. J Vasc Bras, 2015, 14(1): 78-83.
12. Fereydooni A, Stern JR. Contemporary treatment of May-Thurner Syndrome. J Cardiovasc Surg (Torino), 2021, 62(5): 447-455.
13. Yang S, Zhao J, Hou P, et al. Effect of balloon dilatation and stent implantation in iliac vein compression syndrome. Thorac Cardiovasc Surg, 2025 Feb 14. doi: 10.1055/a-2496-5378.
14. 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.
15. 魏強, 王雅潔, 高玉海, 等. 不同介入方法治療急性髂股靜脈血栓合并髂靜脈壓迫綜合征療效比較. 浙江臨床醫學, 2023, 25(7): 1048-1050.
16. Guo Z, Li X, Wang T, et al. Effectiveness of iliac vein stenting combined with high ligation/endovenous laser treatment of the great saphenous veins in patients with Clinical, Etiology, Anatomy, Pathophysiology class 4 to 6 chronic venous disease. J Vasc Surg Venous Lymphat Disord, 2020, 8(1): 74-83.
17. Kong J, Liu P, Li J, et al. Surgical treatment of recurrent varicose veins in the lower limbs associated with endovascular treatment of iliac vein stenosis. Int J Surg, 2018, 50: 110-113.
18. Raju S, Lucas M, Luke C, et al. Long-term improvement of limb reflux prevalence and severity after iliac vein stent placement. J Vasc Surg Venous Lymphat Disord, 2022, 10(3): 640-645.
19. Sawafta K, Yousef F, Hijleh HA, et al. May-Thurner syndrome as an underlying cause of unilateral left-sided deep vein thrombosis in a young healthy female: A case report. Radiol Case Rep, 2025, 20(3): 1740-1744.
20. Zheng B, Liu G, Liu Y. Ultrasound characteristics and risk factors of female patients with pelvic varicose veins and concomitant chronic pelvic pain. J Vasc Surg Venous Lymphat Disord, 2025, 13(2): 102165. doi: 10.1016/j.jvsv.2024.102165.
21. Joh M, Desai KR. Treatment of nonthrombotic iliac vein lesions. Semin Intervent Radiol, 2021, 38(2): 155-159.
22. 中國微循環學會周圍血管疾病專業委員會. 原發性下肢淺靜脈曲張診治專家共識(2021版). 血管與腔內血管外科雜志, 2021, 7(7): 762-772.
23. Stevens SM, Woller SC, Baumann Kreuziger L, et al. Executive summary: Antithrombotic therapy for VTE disease: Second update of the CHEST guideline and expert panel report. Chest, 2021, 160(6): 2247-2259.
24. Baccellieri D, Ardita V, Pannone A, et al. Factors influencing recurrent varicose vein formation after radiofrequency thermal ablation for truncal reflux performed in two high-volume venous centers. J Vasc Surg Venous Lymphat Disord, 2024, 12(2): 101675. doi: 10.1016/j.jvsv.2023.08.014.
25. 黎萬華, 王哲, 趙渝. 髂靜脈壓迫綜合征診療的研究進展. 中國普外基礎與臨床雜志, 2023, 30(2): 230-235.
26. 趙新宇, 陳世遠. 髂靜脈壓迫綜合征診療進展. 中華普通外科學文獻(電子版), 2021, 15(3): 229-233.
27. Bashar K, Shalan A, Sharafat Ali S, et al. Endovascular versus medical treatment of venous compression syndrome of the iliac vein— A systematic review. Vasa, 2021, 50(1): 22-29.
28. Rohlffs F, Spanos K, Debus ES, et al. Modern image acquisition system reduces radiation exposure to patients and staff during complex endovascular aortic repair. Eur J Vasc Endovasc Surg, 2020, 59(2): 295-300.
29. Haufe FL, Wolf P, Riener R, et al. Biomechanical effects of passive hip springs during walking. J Biomech, 2020, 98: 109432. doi: 10.1016/j.jbiomech.2019.109432.
30. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 2016, 149(2): 315-352.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Impact of concurrent iliac vein compression relief on surgical outcomes for great saphenous vein varicosities: A propensity score-matched study

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