Clinical Correlation of Anatomical Location of Nonthrombotic Iliac Vein Lesion

Abstract

Nonthrombotic iliac vein lesions are an active area of research. The advantages of intravascular ultrasound (IVUS) imaging include allowing the exact localization of these lesions. We chose to use IVUS to explore the anatomical location of nonthrombotic iliac vein lesions (NIVLs) and correlate it with clinical findings. Over the course of 7 months, we performed 217 iliofemoral IVUS-assisted studies in 141 women and 76 men. The average ± standard deviation age of examined population was 68 ± 14 years (range, 22-96 years). We used IVUS intraoperatively to measure and record the area of the involved iliofemoral veins. The measurement of stenosis was compared with the adjacent nonstenotic iliofemoral veins. If >50% cross-sectional area or diameter reduction was found by IVUS imaging, it was treated with appropriate balloon size (range 10 × 40 to 16 × 60) and stent (12-to 24-mm diameter × 40-to 90-mm length). We used the Boston Scientific Mobile Cart System IVUS to perform these measurements. We identified 233 lesions: 115 in left lower extremity (LLE) and 118 in the right lower extremity (RLE). The CEAP scores in the LLE were C1: 0; C2: 35; C3: 40; C4: 15; C5: 20; and C6: 6; with the most common site being the proximal common iliac vein in 37.4% (20.86% females and 16.5% males). The CEAP scores in the RLE were C1: 0; C2: 31; C3: 42; C4: 14; C5: 23; and C6: 7; and the most common site was in the middle external iliac vein in 31.35% (20.4% females and 11.01% males). The least common site of the NIVL in the LLE was in the distal external iliac vein in 2.6% (2.6% females and 0% males). In the RLE, the least common site of NIVL was also in the distal external vein 7.62% (5.93% females and 1.69% males). No correlation between age, laterality, gender, or CEAP score were noted. This analysis gives an insight into understanding the anatomical location of the NIVL, which is often an undiagnosed cause of lower extremity venous diseases. Despite multiple questions yet to be answered, the results give an insight to clinicians and researches to guide their treatment and research.