Deep venous thrombosis caused by iliac vein compression syndrome

Abstract

Study objectives: Iliac vein compression syndrome (IVCS) is a clinical condition accompanied by deep venous thrombosis secondary to the compression of the left common iliac vein between the right common iliac artery and the lumbar vertebrae. We reviewed cases of IVCS in the emergency department (ED) compared with the other patients of deep venous thrombosis for the analysis of its clinical characteristics and therapeutic outcomes. Methods: A total of 140 patients with deep venous thrombosis visited the ED of Seoul National University Hospital from January 2000 to December 2002. Of these patients, 20 patients were diagnosed with IVCS. The medical records of the IVCS group (N=20) were retrospectively reviewed and compared with those of the other deep venous thrombosis group (N=120). Results: The IVCS group was 14.3% of total patients with deep venous thrombosis, and mean age of the IVCS group was 55 years. The male to female ratio in the IVCS group was 1:3 and had statistical significance (P=.019). In the IVCS group, there was more cardiovascular disease (P=.029) and less malignancy (P=.044) compared with the deep venous thrombosis group. There were no significant differences between the IVCS group and the deep venous thrombosis group in abnormality of coagulation and pulmonary embolism. Swelling confined to the left lower extremity in all patients and abnormal coagulation panel in 50% of the IVCS group were shown. For the treatment of IVCS, anticoagulation with heparin was done in all patients and thrombolysis with urokinase in 95%. Additionally, balloon angioplasty and metallic stent insertion were performed in 80% and 75% of patients, respectively. Among the 15 patients treated by stent insertion, 10 patients showed no relapse and 2 (13%) patients showed relapse. The remaining 3 patients were lost during the mean follow-up period of 12.8 months. Among 5 patients who did not undergo stent insertion, 2 patients did not have recurring disease, and 3 (60%) patients had recurring disease during the mean follow-up period of 11.2 months. Prognosis of the stent insertion group tended to be good but had no statistical significance (P=.095). Conclusion: IVCS was mainly manifested as swelling confined to the left lower extremity and was more common in female patients. Of the appropriate managements to prevent deep venous thrombosis, stent insertion treatment showed a tendency to reduce the relapse. There needs to be a multicenter study for more analysis of IVCS. Study objectives: Iliac vein compression syndrome (IVCS) is a clinical condition accompanied by deep venous thrombosis secondary to the compression of the left common iliac vein between the right common iliac artery and the lumbar vertebrae. We reviewed cases of IVCS in the emergency department (ED) compared with the other patients of deep venous thrombosis for the analysis of its clinical characteristics and therapeutic outcomes. Methods: A total of 140 patients with deep venous thrombosis visited the ED of Seoul National University Hospital from January 2000 to December 2002. Of these patients, 20 patients were diagnosed with IVCS. The medical records of the IVCS group (N=20) were retrospectively reviewed and compared with those of the other deep venous thrombosis group (N=120). Results: The IVCS group was 14.3% of total patients with deep venous thrombosis, and mean age of the IVCS group was 55 years. The male to female ratio in the IVCS group was 1:3 and had statistical significance (P=.019). In the IVCS group, there was more cardiovascular disease (P=.029) and less malignancy (P=.044) compared with the deep venous thrombosis group. There were no significant differences between the IVCS group and the deep venous thrombosis group in abnormality of coagulation and pulmonary embolism. Swelling confined to the left lower extremity in all patients and abnormal coagulation panel in 50% of the IVCS group were shown. For the treatment of IVCS, anticoagulation with heparin was done in all patients and thrombolysis with urokinase in 95%. Additionally, balloon angioplasty and metallic stent insertion were performed in 80% and 75% of patients, respectively. Among the 15 patients treated by stent insertion, 10 patients showed no relapse and 2 (13%) patients showed relapse. The remaining 3 patients were lost during the mean follow-up period of 12.8 months. Among 5 patients who did not undergo stent insertion, 2 patients did not have recurring disease, and 3 (60%) patients had recurring disease during the mean follow-up period of 11.2 months. Prognosis of the stent insertion group tended to be good but had no statistical significance (P=.095). Conclusion: IVCS was mainly manifested as swelling confined to the left lower extremity and was more common in female patients. Of the appropriate managements to prevent deep venous thrombosis, stent insertion treatment showed a tendency to reduce the relapse. There needs to be a multicenter study for more analysis of IVCS.