Endovascular management of iliac vein compression syndrome: a prospective case series of 61 patients
Ahmed K Gabr, Ahmed K Allam
The Egyptian Journal of Surgery 2019 38(2):180-193
Context Iliac vein compression syndrome (IVCS) or May–Thurner syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression. The pathology of this condition is secondary to a partial obstruction of the common iliac vein by an overlying common iliac artery with subsequent entrapment of the left common iliac vein. Clinical presentations include, but not limited to, pain, swelling, venous stasis ulcers, and skin discoloration. With extensive deep venous thrombosis, postphlebitic syndrome, with all its sequelae, may also develop. Endovascular interventions of this syndrome have become first-line therapy. Aims To estimate the prevalence of IVCS in patients with unilateral left lower limb venous disease [chronic venous disease (CVD)], assess the sensitivity and specificity of modified computed tomography venography in the diagnosis of IVCS, and evaluate the feasibility and effectiveness of the endovascular treatment. Settings and design This was a prospective case series study. The study was performed at three tertiary referral centers in Kingdom of Saudi Arabia (Security Forces Hospital Program, Al-Noor Specialist Hospital, Makkah, Almoosa Specialist Hospital, Al-Ahsaa) and three hospitals in Egypt (Benha University Hospitals, Nile Insurance Hospital, and Kuwaiti Specialized Hospital, Benha). Patients and methods Between March 2015 and February 2018, we evaluated 369 patients with unilateral left lower limb symptomatic CVD in the outpatient clinic of vascular surgery in the study hospitals. Sixty-one symptomatic patients with IVCS who received endovascular treatment were included in our study. Statistical analysis used The initial data entry used Microsoft excel (2010 version) for logical proofreading and analysis. We expressed continuous data as mean±SD and compared continuous variables using two-sided Student’s t tests. We estimated stent patency using Kaplan–Meier method. We considered P value less than 0.05 to be statistically significant. Statistical analysis was performed by using IBM Statistical Package for the Social Sciences software (version 22 for Windows program package). Results The 1-year patency rates in the nonthrombotic and thrombotic IVCS groups were 95.7 and 80%, respectively (P=0.146). The overall primary patency rate at 1 year after treatment was 93%. Complete pain relief was achieved in 76.7% of patients. The overall edema relief rate was 78.1%. Of the 12 limbs with active ulceration before treatment, 10 (83.3%) healed completely. Conclusion IVCS is not an uncommonly encountered condition, especially among patients with unilateral left lower extremity CVD. Computed tomography venography with three-dimensional reconstruction images was more sensitive and specific as a diagnostic approach for IVCS and provided useful information for the endovascular treatment planning. Moreover, endovascular therapy is feasible and effective for treating left-sided IVCS with high technical success rate and with an acceptable complication profile. So, we concluded that endovascular treatment should be considered as the first line of therapy for patients experiencing IVCS.
Ahmed K Gabr, Ahmed K Allam
The Egyptian Journal of Surgery 2019 38(2):180-193
Context Iliac vein compression syndrome (IVCS) or May–Thurner syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression. The pathology of this condition is secondary to a partial obstruction of the common iliac vein by an overlying common iliac artery with subsequent entrapment of the left common iliac vein. Clinical presentations include, but not limited to, pain, swelling, venous stasis ulcers, and skin discoloration. With extensive deep venous thrombosis, postphlebitic syndrome, with all its sequelae, may also develop. Endovascular interventions of this syndrome have become first-line therapy. Aims To estimate the prevalence of IVCS in patients with unilateral left lower limb venous disease [chronic venous disease (CVD)], assess the sensitivity and specificity of modified computed tomography venography in the diagnosis of IVCS, and evaluate the feasibility and effectiveness of the endovascular treatment. Settings and design This was a prospective case series study. The study was performed at three tertiary referral centers in Kingdom of Saudi Arabia (Security Forces Hospital Program, Al-Noor Specialist Hospital, Makkah, Almoosa Specialist Hospital, Al-Ahsaa) and three hospitals in Egypt (Benha University Hospitals, Nile Insurance Hospital, and Kuwaiti Specialized Hospital, Benha). Patients and methods Between March 2015 and February 2018, we evaluated 369 patients with unilateral left lower limb symptomatic CVD in the outpatient clinic of vascular surgery in the study hospitals. Sixty-one symptomatic patients with IVCS who received endovascular treatment were included in our study. Statistical analysis used The initial data entry used Microsoft excel (2010 version) for logical proofreading and analysis. We expressed continuous data as mean±SD and compared continuous variables using two-sided Student’s t tests. We estimated stent patency using Kaplan–Meier method. We considered P value less than 0.05 to be statistically significant. Statistical analysis was performed by using IBM Statistical Package for the Social Sciences software (version 22 for Windows program package). Results The 1-year patency rates in the nonthrombotic and thrombotic IVCS groups were 95.7 and 80%, respectively (P=0.146). The overall primary patency rate at 1 year after treatment was 93%. Complete pain relief was achieved in 76.7% of patients. The overall edema relief rate was 78.1%. Of the 12 limbs with active ulceration before treatment, 10 (83.3%) healed completely. Conclusion IVCS is not an uncommonly encountered condition, especially among patients with unilateral left lower extremity CVD. Computed tomography venography with three-dimensional reconstruction images was more sensitive and specific as a diagnostic approach for IVCS and provided useful information for the endovascular treatment planning. Moreover, endovascular therapy is feasible and effective for treating left-sided IVCS with high technical success rate and with an acceptable complication profile. So, we concluded that endovascular treatment should be considered as the first line of therapy for patients experiencing IVCS.
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