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Epidemiology, diagnosis and management of iliocaval compression syndrome

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    By Katherine Kozlowski, Medical Author and Contributor to Vein News and www.VeinsVensVeins.com

    What is a venocompressive disorder ?

    Venocompressive syndromes predispose patients to venous stasis and an increased risk of deep vein thrombosis (DVT), pulmonary embolism, post phlebitic syndromes and chronic and recurrent venous ulcers in the affected extremity.

    When should venous compressive disorders be considerd ?

    Venous compression should be considered in the differential diagnosis of patients with recurrent DVT and in patients with significant unilateral deep venous insufficiency. 

    Patients with recurrent pulmonary embolism and patients with chronic venous ulcer formation can also have venocompressive disorders. 

    What is iliac vein compression syndrome ? 

    Iliac vein compression syndrome is due to compression of the left common iliac vein by the overlying right common iliac artery. 

    Can iliac vein compression syndrome occur on the right side ?

    It is uncommon but right common iliac vein compression can also occur.  The right common iliac vein can be compressed by the right common iliac artery. 


    What is this syndrome called ?

    The iliocaval compression syndrome is called May-Thurner syndrome.

    What is the prevalence of the May Thurner syndrome ?

    May Thurner syndrome, a venocompressive syndrome, is a prevalent finding in the general population according to a study that I reviewed. The reference for the study is listed below.

    Are a large proportion of patients with iliocaval compression syndrome symptomatic ? 

    The answer is no. 

    It is commonly described that "50% of the population has 25% compression of the left common iliac vein" and "25% of the population has 50% compression of the left iliac vein".

    What proportion of the populaton with iliac vein compression are symptomatic ?

    According to Qais Radaideh and colleagues, "a smaller number of patients are symptomatic".

    Where was the study done ?

    The researchers are from teh Midwest Cardiovascular Research Foundation, Davenport, IA, USA.

    What are the typical presenting symptoms ?

    Patients typically complain of one or more of the following symptoms: lower leg pain, heaviness, venous claudication, swelling, hyperpigmentation and ulceration.

    How does iliac vein compression present?

    Iliocaval compression can be thrombotic, combined with acute or chronic DVT.

    Iliocaval compresiopn can be non-thrombotic.

    How is iliocaval compression diagnosed ? 

    Iliocaval compresion is best diagnosed with intravascular ultrasound (IVUS).

    Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have also been used to make the diagnosis anatomically. 

    What about venography ?

    The authors state that venography underestimates the severity of iliocaval compression but may provide insights into the anatomy and the presence of collaterals in the abdomen and pelvis.

    What is the current strategy to treat iliocaval compression syndrome?

    Based on current available evidence, the authors state that endovascular therapy with stenting remains the main treatment strategy for iliocaval compression syndrome. 

    What types of stents are used to treat iliocaval compression?

    Dedicated nitinol venous stents are currently under review by the Food and Drug Administration for potential approval in the United States. These stents have been released outside the US.

    Is there consensus regarding the optimal manner to treat patients after stenting?

    The authors state that there is no consensus to the optimal anticoagulation regimen following stent deployment for iliocaval compression.

    Oral anticoagulants, however, remain a preferred therapy in patients with history of thrombotic iliocaval compression. 

    Reference:  Radaideh Q, patel NM, Shammas MW.  Iliac vein compression: epidemiology, diagnosis and treatment.  Vasc Health Risk Management 
    2019;  15:115-122.