Diagnosis and endovascular treatment of iliocaval compression syndrome

• Published in: Journal of vascular surgery Vol. 34; no. 1; pp. 106 - 113
• Main Authors: Hurst, Darren R., Forauer, Andrew R., Bloom, Jess R., Greenfield, Lazar J., Wakefield, Thomas W., Williams, David M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2001; Elsevier
• Subjects: Adult; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Catheterization; Constriction, Pathologic; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Iliac Vein - diagnostic imaging; Iliac Vein - pathology; Male; Medical sciences; Peripheral Vascular Diseases - diagnosis; Peripheral Vascular Diseases - diagnostic imaging; Peripheral Vascular Diseases - therapy; Retrospective Studies; Sensitivity and Specificity; Stents; Syndrome; Ultrasonography, Interventional; Vascular Patency; Venous Thrombosis - diagnosis; Venous Thrombosis - therapy; Arterial disease; Vascular disease; Human; Endoprosthesis; Compression; Prognosis; Treatment; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Iliac artery; Inferior vena cava
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2001.114213

Purpose: The purpose of this study was to evaluate the clinical presentation, diagnosis, and endovascular treatment of iliocaval compression syndrome (ICS). Patients and Methods: During a 3-year period, 18 patients (17 women, 1 man; mean age, 42 years) presented with clinical and imaging findings consistent with ICS. All patients were evaluated with venography and Doppler ultrasound (DUS), 13 of 18 with intravascular pressure measurements, 12 of 18 with intravascular ultrasound, 9 of 18 with air plethysmography (APG), and 4 of 18 with magnetic resonance venography. Seventeen patients were treated with endovascular stenting, one was treated with angioplasty alone, and six received adjunct thrombolysis. Results: Despite the presence of stenosis or occlusion in all cases, APG indicated no iliac vein obstruction (outflow fraction ≥ 40%) in nine patients. DUS revealed acute (6) or chronic (7) unilateral iliofemoral deep venous thrombosis in 13 of 18 patients, whereas the results of five of 18 DUS studies were normal. Recanalization and stent placement (n = 17) or angioplasty (n = 1) was achieved in all patients. The average pressure gradient was 5.6 mm Hg preprocedure and 0.6 mm Hg postprocedure. The primary patency rate demonstrated with DUS (n = 17) and venography (n = 7) at 6 months was 89%. The primary patency rate at 12 months was 79%. Conclusions: ICS often presents as sudden unilateral left lower extremity pain and swelling in young to middle-aged female patients after pregnancy, surgery, or a period of inactivity. Venography, intravascular ultrasound, and magnetic resonance venography demonstrate high sensitivity, whereas APG–outflow fraction demonstrates low sensitivity in the diagnosis of ICS. Endovascular stenting and angioplasty provide safe and effective early and intermediate-term treatment of symptomatic ICS. (J Vasc Surg 2001;34:106-13.)