| 1. Kibbe MR, Ujiki M, Goodwin AL, Eskandari M, Yao J, Matsumura J. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004 May;39(5):937-43. |
Review/Other-Dx |
50 patients |
The purpose of this descriptive anatomic study was to determine the incidence of left common iliac vein compression in an asymptomatic population. |
Mean age of subjects without symptoms was 40 years (range, 19-85 years), and 60% (n = 30) were female patients. The mean acute lower extremity venous thrombosis risk factor score was 1.16 +/- 0.23 (range, 0-6; maximum possible score, 28). It was surprising that 24% (n = 12) of patients had greater than 50% compression and 66% (n = 33) had greater than 25% compression. Mean compression of the left common iliac vein was 35.5% (range, -5.6%-74.8%). The structure most often compressing the left common iliac vein against the vertebral body was the right common iliac artery (84%). There was no strong correlation between patient age or common iliac artery size and compression of the left common iliac vein. However, women had greater mean compression of the left common iliac vein (women, 41.2% +/- 3.1%; men, 27.0% +/- 3.0%; P =.003). |
4 |
| 2. Kheyson B, Hingorani A, Ascher E, Ganelin A, Marks N, Iadgarova E. Clinical Correlation of Anatomical Location of Nonthrombotic Iliac Vein Lesion. J Vasc Surg Venous Lymphat Disord. 2(1):116-7, 2014 Jan. |
Review/Other-Dx |
217 patients (141 females, 76 males) |
To use intravascular ultrasound (IVUS) to explore the anatomical location of NIVL and correlate it with clinical findings. |
A total of 233 lesions were identified, with 115 in left lower extremity (LLE) and 118 in right lower extremity (RLE). The CEAP classification score in the LLE were C1, 0; C2, 35; C3, 40; C4, 15; C5, 20; C6, 6; with the most common site being proximal common iliac vein, 37.4% (20.86% females and 16.5% males). The CEAP classification score in the RLE were C1, 0; C2, 31; C3, 42; C4, 14; C5, 23; C6, 7; while most common site was middle external iliac vein, 31.35% (20.4% females and 11.01% males). The least common site of the NIVL was noted in LLE in the distal external iliac vein, 2.6% (2.6% females and 0% males). In the RLE, the least common site of NIVL was also in the distal external iliac vein, 7.62% (5.93% females and 1.69% males). No correlation between age, laterality, gender, or CEAP score has been noted. |
4 |
| 4. Vedantham S, Weinberg I, Desai KR, et al. Society of Interventional Radiology Position Statement on the Management of Chronic Iliofemoral Venous Obstruction with Endovascular Placement of Metallic Stents. Journal of Vascular & Interventional Radiology. 34(10):1643-1657.e6, 2023 10. |
Review/Other-Tx |
N/A |
To state the position of the Society of Interventional Radiology (SIR) on the endovascular management of chronic iliofemoral venous obstruction with metallic stents. |
A total of 41 studies, including randomized trials, systematic reviews and meta-analyses, prospective single-arm studies, and retrospective studies were identified. The expert writing group developed 15 recommendations on the use of endovascular stent placement. |
4 |
| 7. Kutsenko O, McColgan Y, Salazar G. Iliac Vein Stenosis: Is the Data Strong Enough for Stenting in the Young Pelvic Venous Disorders (PeVD) Population?. [Review]. Tech Vasc Interv Radiol. 24(1):100733, 2021 Mar. |
Review/Other-Dx |
N/A |
To discuss the current evidence available for this intervention and clinical issues to consider when evaluating these patients. |
No results stated in abstract. |
4 |
| 9. Krzanowski M, Partyka L, Drelicharz L, et al. Posture commonly and considerably modifies stenosis of left common iliac and left renal veins in women diagnosed with pelvic venous disorder. Journal of Vascular Surgery. 7(6):845-852.e2, 2019 11.J Vasc Surg Venous Lymphat Disord. 7(6):845-852.e2, 2019 11. |
Review/Other-Dx |
41 women |
To test the hypothesis that postural changes may significantly affect the CSA of the LRV and LCIV. |
A total of 41 women were examined. Significant stenosis of the LRV was seen in 22 patients (55%) supine but in only 4 (10%) patients studied when lying on the left side and in 27 (67.5%) patients studied while standing. Significant stenosis of the LCIV was seen in 26 supine patients (63.4%), in 8 lying on the left side (19.5%), and in 10 (24.4%) standing. |
4 |
| 11. Shi WY, Xue HL, Chen L, Gu JP. Non-enhanced multimodal magnetic resonance imaging in assessment of iliac vein obstruction with or without thrombosis. Abdom Radiol. 46(9):4432-4439, 2021 09. |
Observational-Dx |
73 patients |
To evaluate the diagnostic accuracy of a contrast-free multimodal magnetic resonance (MR) protocol (including M2DIPEAR, THRIVE, BTFE-SPAIR, and FLAIR sequences) in the detection of iliac vein obstruction with or without thrombosis. |
Iliac vein obstruction was depicted with DSA in 64 patients. In per-patient evaluation, the multimodal MR imaging yielded accuracy of 95.9% (70/73), sensitivity of 96.9% (62/64), specificity of 88.9% (8/9), positive predictive value of 98.4% (62/63), and negative predictive value of 80% (8/10), respectively. In the multimodal MR sequences, balanced turbo field echo-spectral attenuated inversion recovery (BTFE-SPAIR) sequence was superior to other sequences in depicting the iliac vein configuration, but fluid attenuated inversion recovery (FLAIR) and T1 high-resolution isovolumetric examination (THRIVE) seemed superior in detecting co-existing venous thrombosis. |
3 |
| 12. 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. 28:10760296221127275, 2022 Jan-Dec. |
Review/Other-Dx |
105 patients |
To assess the image quality and diagnostic performance of a magnetic resonance imaging technique, black-blood venous imaging (BBVI), in detecting IVCS by comparing it with contrast-enhanced computed tomography venography (CTV) and using invasive digital subtraction angiography (DSA) as the reference. |
BBVI demonstrated high sensitivity, specificity, and accuracy for the diagnosis of IVCS, without contrast agents. BBVI and CTV are quite in diagnosis IVCS. Quite SE (67.8% vs 68.3%), SP (94.8% vs 94.8%), PPV (98.0% vs 98.0%), NPV (46.2% vs 46.9%) and ACC (75.3% vs 75.7%) were obtained by BBVI in comparison with CTV. |
4 |
| 13. Peng G, Zhu W, Zuo Z, et al. Efficacy of modified time of flight magnetic resonance venography in diagnosis of iliac vein compression syndrome. Eur J Radiol. 166:111020, 2023 Sep. |
Observational-Dx |
69 patients who underwent TOF-MRV and 85 patients who received mTOF-MRV |
The diagnostic efficacy of modified time of flight magnetic resonance venography (mTOF-MRV) for iliac vein compression syndrome diagnosis by optimizing the scanning parameters and improving image quality. |
Inter-observer assessment of objective data measurement revealed excellent agreement {ICC [95% confidence interval (CI)]: 0.972 (0.953 to 0.983) for TOF-MRV and 0.979 (0.965 to 0.988) for m-TOF MRV, 0.976 (0.960 to 0.986) for DSA}. The mean error of stenosis rate of mTOF-MRV was markedly smaller than that of TOF-MRV (p < 0.05). Sensitivity, specificity, positive and negative predictive values of TOF-MRV in the diagnosis of significant stenosis were 100%, 95%, 67% and 100%, respectively. The sensitivity, specificity, positive and negative predictive values of mTOF-MRV were 100%. The mean image score for the mTOF-MRV was 3.63 ± 0.59, which was significantly higher compared with that of TOF-MRV (2.19 ± 0.42). |
2 |
| 14. 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. 8(3):413-422, 2020 05. |
Review/Other-Dx |
50 patients |
To investigate power of computed tomography venography (CTV) to identify and characterize iliac vein obstruction (IVO) compared with intravascular ultrasound (IVUS) examination in highly symptomatic patients with chronic venous disease (CVD). |
The CTV point of maximum IVO was 80% in the left limb, 10% in the right limb, 10% bilaterally; 2% in the inferior vena cava; 91% in the common iliac vein (CIV) confluence (41.6% below the CIV confluence, 34.5 at the CIV confluence, and 23.9% above the CIV confluence); 7% at the external iliac vein (kappa index 0.841; P < .001, when compared with IVUS). The distal venous segment considered free of obstruction was above inguinal ligament: 68% (CIV, 47%; external iliac vein, 21%) 32% below the inguinal ligament (common femoral vein, 26%; deep femoral vein, 6%) (kappa index 0.671; P = .023, when compared with IVUS). The power of CTV to detect an IVO of 50% or greater (groups II and III) when compared with IVUS achieved a sensitivity and specificity ratio of 94.0% and 79.2%, respectively. The positive predictive value was 94%, the negative predictive value was 79.1%, accuracy was 86.7% (kappa, 0.733), and interobserver agreement was 92.1% (95% confidence interval, 87.1-97.7; kappa, 0.899). |
4 |
| 15. Raju S, Walker W, Noel C, Kuykendall R, Jayaraj A. The two-segment caliber method of diagnosing iliac vein stenosis on routine computed tomography with contrast enhancement. J Vasc Surg Venous Lymphat Disord. 8(6):970-977, 2020 11. |
Review/Other-Dx |
91 limbs |
To compare the diagnostic accuracy of the two-segment caliber method of CTV (arm vein injection of contrast material) with IVUS. |
On IVUS evaluation, 84% of CIVs and 78% of EIVs were stenotic and 16% and 22% were of normal caliber. These provided IVUS positive and negative controls for CTV comparison. On CTV, at least one of the two segments (CIV or EIV) was stenotic in 90% of the limbs, about 10% to 15% higher than single-segment involvement. Mean CTV caliber difference from IVUS was +2.5% for CIV and +7.3% for EIV. On Bland-Altman plot, single-segment diagnostic sensitivity of CTV was 83% and 73% for CIV and EIV, respectively, compared with IVUS. The sensitivity increased to 97% with a positive predictive value and accuracy of 93% and 91%, respectively, when a stenotic caliber in at least one of the two segments was considered diagnostic of iliac vein stenosis. Receiver operating characteristic analysis confirmed increased accuracy of the two-segment method over single-segment assessment with an area under the curve of 0.89 (P < .001). |
4 |
| 16. Yin L, Wang X, Wei X, et al. Diagnostic Value of the Iliac Vein Stenosis Percentage Combined With Indicators of Venous Reflux for Iliac Vein Compression Syndrome With Computed Tomography Venography. J Comput Assist Tomogr. 46(5):722-728, 2022 Sep-Oct 01. |
Review/Other-Dx |
264 patients |
To identify a cutoff value of iliac vein stenosis in computed tomography venography (CTV) for assisting in the diagnosis of iliac vein compression syndrome (IVCS). |
With respect to the DSV results, the area under the curve was 0.797 ( P < 0.001). The best cutoff value was 46.67%, corresponding to a sensitivity of 83.44% and a specificity of 69.31% for predicting IVCS. Moreover, the combination diagnostic method had higher sensitivity and accuracy (94.48% vs 83.44% [ P = 0.01] and 84.85% vs 78.03% [ P = 0.04], respectively). |
4 |
| 17. Abdalla Ahmed S, Elbadawy A, Khalaf LMR, Samy M. Iliac vein obstruction: accuracy of Direct Multidetector Computed Tomographic Venography and duplex ultrasound. Br J Radiol. 2024 Oct 14. |
Observational-Dx |
94 patients |
To evaluate the accuracy of direct computed tomographic venography (DCTV) and duplex ultrasound (DUS) in the identification of iliac vein obstruction in highly symptomatic patients with severe chronic venous disease (CVD) compared with intravascular ultrasound (IVUS). |
Of the 94 patients with CVD, IVUS identified iliac vein obstruction in 55 (58.5%) patients (25.5% was grade 1, 27.3% was grade 2, 47.3% was grade 3). The sensitivity, specificity of DCTV in diagnosing obstruction were 96%, 95% in grade 1; 100%, 100% grade 2; 100%, 100% in grade 3, respectively. The sensitivity, specificity of DUS were 63.9%, 65% in grade 1; 68%, 82% in grade 2, and 70%, 85% in grade 3, respectively. The overall agreement of DUS was 0.73 (95% CI, 0.70-0.79), and DCTV was 0.96 (95% CI, 0.91-0.97). |
1 |
| 18. Gagne PJ, Tahara RW, Fastabend CP, et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord. 5(5):678-687, 2017 09. |
Observational-Dx |
100 patients |
To compare the diagnostic efficacy of intravascular ultrasound (IVUS) with multiplanar venography for iliofemoral vein obstruction. |
Venography identified stenotic lesions in 51 of 100 subjects, whereas IVUS identified lesions in 81 of 100 subjects. Compared with IVUS, the diameter reduction was on average 11% less for venography (P < .001). The intraclass correlation coefficient was 0.505 for vein diameter stenosis calculated with the two methods. IVUS identified significant lesions not detected with three-view venography in 26.3% of patients. Investigators revised the treatment plan in 57 of 100 cases after IVUS, most often because of failure of venography to detect a significant lesion (41/57 [72%]). IVUS led to an increased number of stents in 13 of 57 subjects (23%) and the avoidance of an endovascular procedure in 3 of 57 subjects (5%). Overall, IVUS imaging changed the treatment plan in 57 patients; 54 patients had stents placed on the basis of IVUS detection of significant iliofemoral vein obstructive lesions not appreciated with venography, whereas 3 patients with significant lesions on venography had no stent placed on the basis of IVUS. |
3 |
| 19. Lau I, Png CYM, Eswarappa M, et al. Defining the utility of anteroposterior venography in the diagnosis of venous iliofemoral obstruction. Journal of Vascular Surgery. 7(4):514-521.e4, 2019 07.J Vasc Surg Venous Lymphat Disord. 7(4):514-521.e4, 2019 07. |
Review/Other-Dx |
107 patients |
To further elucidate where and how anteroposterior venography may successfully guide the diagnosis of venous obstruction. |
There were 107 patients who underwent venous stenting guided by venography and IVUS in this study. Six patients who underwent reoperation, 1 patient who had an acute preoperative deep vein thrombosis, and 14 patients who had incomplete records were excluded. Thus, 86 patients with 77 left lower extremity and 68 right lower extremity studies were available for analysis. The sensitivity by stenosis on venography was 4% in the left common iliac vein (CIV), 44% in the left external iliac vein (EIV), and 44% in the common femoral vein (CFV). The sensitivity by stenosis on venography in the right CIV, EIV, and CFV was 21%, 46%, and 40%, respectively. Combined, pancaking and collaterals had a sensitivity of 97% in the left CIV. IVUS resulted in a change in plan in 2%, 32%, and 48% of patients in the left CIV, EIV, and CFV, and in 26%, 35%, and 48% of patients in the right CIV, EIV, and CFV, respectively. |
4 |
| 21. Kim ES, Sharma AM, Scissons R, et al. Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound. Vasc Med. 2020 Oct;25(5):484-506. |
Review/Other-Dx |
N/A |
To review Doppler waveform alterations with physiologic changes and disease states, provides optimization techniques for waveform acquisition and display, and provides practical guidance for incorporating the proposed nomenclature into the final interpretation report. |
No results stated in abstract. |
4 |
| 22. Raju S, Walker W, Noel C, Kuykendall R, Powell T, Jayaraj A. Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis. Vasc Med. 26(5):549-555, 2021 10. |
Observational-Dx |
382 limbs |
Minimum iliac vein caliber necessary to maintain normal peripheral venous pressure can be derived by the Poiseuille equation. Duplex was compared to intravascular ultrasound (IVUS) in the assessment of iliac vein stenosis in this single center retrospective study. |
Parallel IVUS and duplex caliber data for common iliac vein (CIV) and external iliac vein (EIV) in 382 limbs were separately compared. One or both segments were stenotic by IVUS criteria in 213 limbs. Neither segment was stenotic by IVUS in 22 limbs. Bland-Altman analyses and Passing-Bablok linear regressions were used. Duplex calibers were dimensionally smaller than corresponding IVUS images of CIV and EIV segments in Bland-Altman comparison by a mean of 54 mm2 and 34 mm2, respectively. Passing-Bablok regression suggested the difference was due to a systematic bias and not proportional. Duplex yields a smaller cross-sectional image of CIV and EIV compared to IVUS. Duplex is not a reliable diagnostic test for iliac vein stenosis. |
3 |
| 23. Hugel U, Khatami F, Muka T, et al. Criteria to predict midterm outcome after stenting of chronic iliac vein obstructions (PROMISE trial). J Vasc Surg Venous Lymphat Disord. 11(1):91-99.e1, 2023 01. |
Observational-Tx |
108 consecutive patients |
To identify factors associated with loss of patency to facilitate patient selection for endovenous stenting. |
The mean follow-up duration was 41 ± 26 months, and participants had a mean age of 47.4 ± 15.4 years with 46.3% women. Ninety (83.3%) patients had PTO and 18 (16.7%) had nonthrombotic iliac vein lesions, predominantly due to May-Thurner syndrome. Loss of patency occurred in 20 (18.5%) patients, all treated for PTO. Comorbidities, side of intervention, and sex did not differ between patients with occluded and patent stents. Stent occlusion was more common with increasing number of stents implanted (P < .001) and with distal stent extension into and beyond the CFV (P < .001). Preinterventional predictive factors for stent occlusion were lower duplex ultrasound peak velocity in the CFV (odds ratio [OR]: 7.52, 95% confidence interval [CI]: 2.54-22.28; P < .001) and FV (OR: 10.75, 95% CI: 2.07-55.82; P < .005), and post-thrombotic changes in the deep femoral vein (OR: 4.51, 95% CI: 1.53-13.25; P = .006) and FV (OR: 3.62: 95% CI: 1.11-11.84; P = .033). Peak velocities of =7 cm/s (interquartile range: 0-20 cm/s) in the CVF and =8 cm/s (interquartile range: 5-10 cm/s) in the FV were significantly associated with loss of patency. |
2 |
| 24. Kim JH, Bae SM, Park SK. Ipsilateral leg swelling after renal transplantation as an alarming sign of Iliac vein stenosis. Kidney Res Clin Pract. 33(4):217-21, 2014 Dec. |
Review/Other-Tx |
56-year-old renal transplant recipient |
To describe a case of iliac vein stenosis that developed 16 years after transplantation in a 56-year-old renal transplant recipient. |
Computed tomography excluded deep vein thrombosis and revealed tight iliac vein stenosis on the side of the renal transplant. Following angiographic confirmation of the stenosis, endovascular treatment was successfully performed with a purposefully designed, self-expanding, venous stent. Ipsilateral leg swelling is an alarming sign for the diagnosis of iliac vein stenosis after renal transplantation. Percutaneous intervention with venous stent placement seems to be a safe and effective treatment of this rare condition. |
4 |
| 25. Raju S, Lucas M, Thaggard D, Saleem T, Jayaraj A. Plethysmographic features of calf pump failure in chronic venous obstruction and reflux. J Vasc Surg Venous Lymphat Disord. 11(2):262-269, 2023 03. |
Review/Other-Dx |
13,234 limbs in 8813 patients |
To provide an analysis of the APG parameters in this nonrefluxive subset and compare it with a case control cohort of CPF in refluxive limbs. |
There were 7780 (59%) limbs with reflux and 5454 (41%) that were nonrefluxive. Supine venous pressure, an index of venous obstruction, was elevated in both subsets. The incidence of CPF was 25% in refluxive limbs and 16% in nonrefluxive limbs totaling 2790 limbs. Venous volume and venous filling index were significantly elevated (P = .0001) in refluxive limbs compared to nonrefluxive limbs. The EF was diminished (<50%) in all CPF limbs except in a small fraction (n = 427 [3%]). Stent correction of iliac vein stenosis corrected CPF, normalizing the RVF in both subsets. |
4 |
| 26. Pei Y, Liu Q, Li X. Haemodynamic study of left nonthrombotic iliac vein lesions: a preliminary report. Sci Rep. 2024 Aug 13;14(1):18837. |
Experimental-Tx |
24 patients (7 males ,17 females) |
This study aimed to provide objective evidence for the diagnosis and treatment of nonthrombotic iliac vein lesions (NIVLs). |
Pressure at the caudal end of the stenotic left common iliac vein (LCIV) segment, local blood flow velocity, and time-averaged wall shear stress in the stenotic segment exhibited positive correlations with the clinical CVI classification (R = 0.92, p < 0.001; R = 0.94, p < 0.001; R = 0.87, p < 0.001), while the relative retention time showed a negative correlation (R = -0.94, p < 0.001). The pressure difference (?P) between the two ends of the stenotic segment and the velocity difference (?V) between the stenotic segment and the caudal end were positively correlated with the clinical classification (R = 0.92, p < 0.001; R = 0.9, p < 0.001). The cross-sectional area stenosis rate and length of the stenotic LCIV segment were positively correlated with the clinical classification (R = 0.93, p < 0.001; R = 0.63, p < 0.001). The results suggest that haemodynamic assessment of the iliac vein could effectively portray blood flow disturbances in stenotic segments of the LCIV, potentially reflecting the degree of iliac vein stenosis. Haemodynamic indicators are correlated with the severity of clinical CVI symptoms. |
2 |
| 27. Jones TM, Cassada DC, Heidel RE, et al. Maximal venous outflow velocity: an index for iliac vein obstruction. Ann Vasc Surg. 26(8):1106-13, 2012 Nov. |
Review/Other-Dx |
12 |
Modified the technique of duplex ultrasonography to evaluate the flow characteristics of the leg after tourniquet-induced venous engorgement, with the objective of revealing iliocaval obstruction characteristic of MTS. |
Twelve patients with signs and symptoms of MTS were compared with healthy control subjects for duplex-derived maximal venous outflow velocity (MVOV) after tourniquet-induced venous engorgement of the leg. The data for healthy control subjects were obtained from a previous study of asymptomatic volunteers using the same MVOV maneuvers. The tourniquet-induced venous engorgement mimics that caused during vigorous exercise. A right-to-left ratio of MVOV was generated for patient comparisons. Patients with clinical evidence of MTS had a mean right-to-left MVOV ratio of 2.0, asymptomatic control subjects had a mean ratio of 1.3, and MTS patients who had undergone endovascular treatment had a poststent mean ratio of 1.2 (P = 0.011). |
4 |
| 28. Müller M, Wolf F, Loewe C, et al. Preprocedural imaging modalities in patients undergoing iliocaval venous recanalization and stent placement. Vasc Med. 2023 Aug;28(4):315-323. |
Observational-Dx |
108 patients (80 patients with postthrombotic obstructions, 28 patients with NIVL) |
To determine the diagnostic accuracy of preinterventional imaging modalities in patients being evaluated for iliocaval venous recanalization and stent placement. |
A total of 216 limbs in 108 patients (80 patients with postthrombotic obstructions, 28 patients with NIVL) were examined. In patients with postthrombotic obstructions, the diagnostic sensitivities for the detection of lesions of the common femoral vein were 81% (95% CI 71–89%) for DUS, 76% (95% CI 65–85%) for MRV, and 86% (95% CI 76–93%) for MPV. The sensitivities for detecting lesions of the iliac veins were 96% (95% CI 89–99%) for DUS, 99% (95% CI 92–100%) for MRV, and 100% (95% CI 94–100%) for MPV. Regarding the inferior vena cava, the sensitivities were 44% (95% CI 24–65%) for DUS, 52% (95% CI 31–73%) for MRV, and 70% (95% CI 47–86%) for MPV. The sensitivities for detecting NIVL were 58% (95% CI 34–79%) for DUS, 90% (95% CI 68–97%) for MRV, and 95% (95% CI 73–99%) for MPV. |
3 |
| 29. Massenburg BB, Himel HN, Blue RC, Marin ML, Faries PL, Ting W. Magnetic Resonance Imaging in Proximal Venous Outflow Obstruction. Ann Vasc Surg. 2015 Nov;29(8):S0890-5096(15)00619-6. |
Observational-Dx |
46 patients |
To determine the value and utility of magnetic resonance venography (MRV) in diagnosis and screening for proximal venous outflow obstruction (PVOO). |
When compared with IVUS and multiplane venography, the interpretation of MRV had a sensitivity of 100% and a specificity of 22.7%. The positive predictive value of MRV was 58.5%, and the negative predictive value was 100%. |
3 |
| 30. Finkelstein ER, Crist TE, Shao T, Mella-Catinchi J, Xu KY. The utility of computed tomography venography in the routine evaluation of patients who present to a lymphedema center with lower extremity edema. J Vasc Surg Venous Lymphat Disord. 11(5):1055-1062, 2023 09. |
Observational-Dx |
121 patients |
The objective of this study is to determine the utility of routine computed tomography venography (CTV) screening for these patients by evaluating the proportion presenting with clinically significant CTV-identified left IVO. |
Of the patients with complete imaging studies, 49% (n = 25) had abnormal lymphoscintigraphy findings, 45% (n = 46) had reflux on ultrasound, and 11.4% (n = 9) had IVO on CTV. Seven patients (6%) had CTV findings of IVO and edema of either the isolated left (n = 4) or bilateral (n = 3) lower extremities. Cases of IVO on CTV were determined by the multidisciplinary team to be the predominant cause of lower extremity edema for three of these seven cases (43%; or 2.5% of all 121 patients). |
3 |
| 31. Neglen P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 35(4):694-700, 2002 Apr. |
Observational-Dx |
304 limbs |
Comparison of intravascular ultrasound scanning (IVUS) with transfemoral venography in the assessment of chronic iliac vein obstruction. |
With IVUS, fine intraluminal and mural details were detected (eg, trabeculation, frozen valves, mural thickness, and outside compression) that were not seen with venography. The median stenosis (with diameter reduction) on venographic results was 50% (range, 0 to 100%) and on IVUS results was 80% (range, 25% to 100%). In a comparison with IVUS as the standard, venography had poor sensitivity (45%) and negative predictive value (49%) in the detection of a venous area stenosis of >70%. The actual stenotic area was more severe when measured directly with IVUS (0.31 cm2; range, 0 to 1.68 cm2) versus derived (0.36 cm2; range, 0 to 3.08 cm2; P <.001), probably as a result of the noncircular lumen geometry of the stenosis. No correlation was found between any of the preoperative or intraoperative pressure measurements and degree of stenosis with or without collaterals. When collaterals were present, a more severe stenosis (median, 85%; range, 25% to 100%) was observed (versus a 70% stenosis in the absence of collaterals; range, 30% to 99%; P <.001), along with actual stenotic area (with collaterals: median, 0.24 cm2; range, 0 to 1.18 cm2; without collaterals: median, 0.45 cm2; range, 0.02 to 1.68 cm2; P <.01) and a higher rate of hyperemia-induced pressure gradient (=2 mm Hg; with collaterals, 34%; without collaterals, 11%; P <.05). |
3 |
| 32. Saleem T, Raju S. Evaluation of the diagnostic accuracy of contrast enhanced ultrasonography in chronic iliac venous obstruction. J Vasc Surg Venous Lymphat Disord. 2025 May;13(3):S2213-333X(24)00421-9. |
Observational-Dx |
39 patients suspected with chronic iliac venous obstruction |
To examine the diagnostic accuracy of CEUS utilizing Lumason (Bracco Diagnostics Inc) and compare it with unenhanced ultrasonography in CIVO using IVUS as a reference standard. |
Most of the data set was female, had post thrombotic lesions, and belonged to CEAP Class C4 or higher. The intraclass correlation coefficient (kappa, average measures) between enhanced and unenhanced ultrasonography was 0.9 (95% confidence interval [CI], 0.87-0.92), indicative of very good agreement. However, the correlation coefficients between enhanced ultrasonography and IVUS and unenhanced ultrasonography and IVUS were 0.6 (95% CI, 0.16-0.67) and 0.5 (95% CI, 0.37-0.75), respectively, indicative of less optimal agreement. Considering IVUS as the reference standard, diagnostic accuracies for ultrasonography for external iliac vein with and without Lumason use were 71.3% and 71.4%, respectively. Diagnostic accuracies for ultrasonography for common iliac vein with and without Lumason use were 53.2% and 56.7%, respectively, when compared with IVUS. |
3 |
| 33. van Vuuren TMAJ, Kurstjens RLM, Wittens CHA, van Laanen JHH, de Graaf R. Illusory Angiographic Signs of Significant Iliac Vein Compression in Healthy Volunteers. Eur J Vasc Endovasc Surg. 56(6):874-879, 2018 Dec. |
Review/Other-Dx |
20 patients |
The aim of the current study was to assess the prevalence of angiographic signs of iliac vein compression in a group of healthy participants and to analyse the opinions for treatment of iliac vein compression in a selected group of clinicians. |
In 16 (80%) participants, at least two signs indicative of May-Thurner compression were seen. In three (15%) subjects, narrowing of the common iliac vein without collaterals was shown and one (5%) did not show any signs of obstruction. In 23 (70%) of the survey responders, collaterals were found to be the most typical sign indicative of significant venous obstruction. An angiographic sign of >50% compression was found to be an indication to stent in 55% of responders. |
4 |
| 34. Xu Y, Wu J, Cheng Y, et al. Evaluation of 3-dimensional rotational venography for the diagnosis of non-thrombotic iliac venous lesion. Front Cardiovasc Med. 2023;10():1088224. |
Observational-Dx |
61 patients |
To determine the technical feasibility and safety of 3D rotational venography (3D-RV) in the diagnosis of non-thrombotic iliac vein lesions compared with traditional 2D-digital subtraction angiography (2-DSA). |
A total of 61 consecutive patients with symptomatic NIVL from our institution were enrolled in this study. With the aggravation of iliac vein stenosis, the proportion of indicators such as contralateral formation and iliac vein compression indentation reflecting the severity of compression under 3D-RV reconstruction increased significantly. Also, significant differences were observed between the 3D-RV and 2-DSA groups concerning procedure time (10.56 ± 0.09 s vs. 12.59 ± 0.37 s; p < 0.01), X-ray dose (41.25 ± 0.21 mGy vs. 81.59 ± 1.69 mGy; p < 0.01) and contrast agent dosage (21.48 ± 0.24 mL vs. 33.69 ± 0.72 mL; p < 0.01). Contralateral iliac vein imaging (p = 0.002), pelvic collateral vein imaging (p = 0.03), and external iliac vein indentation (p = 0.001) were found to influence the severity of iliac vein compression. |
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| 36. Trzesniowski A, Lakhanpal G, Sulakvelidze L, Kennedy R, Lakhanpal S, Pappas PJ. Long-term follow-up for the treatment of symptomatic pelvic venous insufficiency secondary to combined iliac vein stenosis and ovarian vein reflux treated with iliac vein stenting alone. Journal of Vascular Surgery. 13(1):101990, 2025 Jan.J Vasc Surg Venous Lymphat Disord. 13(1):101990, 2025 Jan. |
Review/Other-Dx |
141 patients |
To determine the long-term effectiveness of this treatment strategy, the poststent reintervention rate and the incidence of poststent ovarian vein embolization (OVE) for residual symptoms. |
From February 2018 to January 2023, 141 women with a pelvic venous disorder secondary to IVS and OVR were identified. The average age was 44.7 ± 10.5 years with 3.18 ± 1.82 pregnancies. The average follow-up time for the entire cohort was 12.0 ± 12.1 months (median, 10.65 months). Types of stents were Venovo 48 (34%), Wallstent 14 (10%), and Abre 79 (56%). The most common diameter and stent lengths used were 14 and 16 mm and 140 and 150 mm, respectively. The most common vein territories covered were the inferior vena cava to the left external iliac vein in 83% and inferior vena cava to right external iliac vein in 13%. Pelvic and dyspareunia VAS scores before the intervention and at 3, 6, 12, 24, and 36 months after the intervention were as follows: 6.4 ± 73 (n = 141), 2.6 ± 3.3 (n = 98), 1.71 ± 2.83 (n = 77), 2.04 ± 3.5 (n = 76), 2.4 ± 3.7 (n = 30), and 1.15 ± 3 (n = 13) (P = .001). Of the entire cohort no patients required OVE and pelvic reservoir embolization. Pelvic reservoirs were present in 113 of 141 patients (83%). Stent reinterventions were required in 19 of 141 patients (13%). |
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| 37. Calcagno T, Sulakvelidze L, Kennedy R, et al. Transabdominal ultrasound accurately identifies a significant iliac vein area-reducing lesion in patients with pelvic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 11(6):1213-1218, 2023 Nov. |
Observational-Dx |
96 patients treated for symptomatic PVI |
To determine the accuracy of TAU for determining the presence of an iliac vein area-reducing lesion compared with intravascular ultrasound (IVUS). |
The average age of the entire cohort was 49.8 ± 13.5 years, with 69 women and 27 men. The CEAP distribution was as follows: C0, 5%; C1, 5%; C2, 10%; C3, 40%; C4a,b, 30%; C5, 7%; and C6, 3%. The average revised venous clinical severity score was 6.2 ± 2.6. The indications for intervention were leg symptoms alone in 43%, pelvic symptoms alone in 3%, and combined leg and pelvic symptoms in 54%. TAU identified a stenosis of =50% in 92 of the 96 patients (96%). For a =50% stenosis, a normalized diameter of =3 mm demonstrated a sensitivity, specificity, and positive and negative predictive value of 75%, 75%, 98%, and 12%, respectively. Logistic regression analysis indicated that TAU was significant in predicting the presence of a =60% area-reducing lesion (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P = .009). The area under the receiver operating characteristic curve (c-statistic) was 68.6%. The sensitivity, specificity, and positive and negative predictive values were 66.7%, 66.7%, 81.5%, and 47.6%, respectively, for a normalized diameter of =4 mm. |
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| 38. Larkin TA, Hovav O, Dwight K, Villalba L. Common iliac vein obstruction in a symptomatic population is associated with previous deep venous thrombosis, and with chronic pelvic pain in females. J Vasc Surg Venous Lymphat Disord. 8(6):961-969, 2020 11. |
Review/Other-Dx |
421 patients undergoing venous duplex ultrasound |
To determine the incidence of common iliac vein obstruction, gonadal vein incompetence, and renal vein compression/stenosis and to ascertain which referral reasons were associated with common iliac vein obstruction and gonadal vein incompetence in a population symptomatic for chronic venous insufficiency. |
Among 421 patients (78.6% female; 57.7 ± 16.7 years), 46.7% had iliac vein obstruction, 40.1% had gonadal vein incompetence, and 29.9% had renal vein compression/stenosis. Venous disorders were significantly more prevalent among female patients and on the left side. The most common referral reasons were varicose veins for both sexes, followed by lower limb pain for females and lower limb edema for males, none of which were associated with any venous obstruction or incompetence. Previous DVT was significantly associated with common iliac vein obstruction for all patients (ß = .189; P = .001), despite its being a previous known diagnosis for only 11.4% of patients. Among females, CPP was also significantly associated with common iliac vein obstruction and gonadal vein incompetence (ß = .246 [P < .001] and ß = .201 [P = .012], respectively). Among those with CPP in this study, common iliac vein obstruction, with and without gonadal vein incompetence (33% and 35%, respectively), was more prevalent than gonadal vein incompetence alone (14%). |
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| 39. Raju S, Davis M. Anomalous features of iliac vein stenosis that affect diagnosis and treatment. J Vasc Surg Venous Lymphat Disord. 2(3):260-7, 2014 Jul. |
Review/Other-Dx |
Plain old balloon angioplasty (n = 48) and in-stent restenosis (n = 99) |
To report on three such anomalous features that we have noted previously in anecdotal form: (1) a unique form of a long and diffuse stenosis (Rokitansky stenosis) that may escape diagnosis with conventional techniques; (2) the invariable failure of plain old balloon angioplasty (POBA) to relieve iliac vein stenosis (both focal and diffuse); and (3) the stent compression by venous strictures, whether focal or diffuse, extrinsic to the stent. |
The incidence of Rokitansky stenosis without focal lesions was 1.5%. After POBA, stenotic area increased from a median of 60 mm(2) to 62 mm(2), a miniscule improvement. Lumen area increased to a nearly "normal" 172 mm(2) after stent placement. In 103 limbs with residual or recurrent symptoms, in-stent restenosis (ISR) was present in all limbs; additional stent compression was evident in 25% of the limbs, adding to the overall severity of the stenosis. ISR responded well to high-pressure balloon dilation, with total clearance in 62% of treated limbs and substantial improvement in others. In contrast, stent compression was resistant, remaining unchanged in 68% after balloon dilation. |
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