Novel typing of iliac vein compression in asymptomatic individuals evaluated by contrast enhanced CT

Jiaying Li,Kefeng Zhou,Maosheng Xu,Zhichao Sun,Wujie Chen,Zhichao Xu,Haibo Chen

doi:10.1007/s00276-021-02678-w

Abstract

PurposeCompression of the iliac vein between the iliac artery and lumbosacral vertebra can cause iliac vein compression syndrome (IVCS). The purpose of this study is to assess compression characteristics and establish a new sub-typing in asymptomatic IVCS individuals using contrast-enhanced CT.MethodsA retrospective analysis of abdomen contrast-enhanced CT images from 195 asymptomatic subjects with iliac vein compressed was investigated. Patients had no history of venous pathology, and images were collected from June 2018 to January 2019. Qualitative and quantitative characteristics of compression were examined including the location, pattern, minor diameter, area, and the percentage compression on an orthogonal section by the post-processing of multiple planar reconstruction and volume rendering.ResultsThere were 107 females and 88 males with age range 18–92 years. The most common site of iliac vein compression was localized to the left common iliac vein (LCIV) (178/195, 91.3%). Notably, four compression types (type I–IV) were established according to the compression location, with type II being the most common. The four compression types had differences in the upper limit and fluctuation range of compression. It was found that the average level of iliac vein compression was below 25%. The compression degree of the left common iliac vein in type II was relatively concentrated, and the upper limit of compression was close to 70%.ConclusionAsymptomatic iliac vein compression was categorized according to compression location. The proposal of four types might help clinicians to predict which IVCS patients would benefit from interventional therapy.

Highlights

Compression of the iliac vein between the iliac artery and lumbosacral vertebra causes deep vein thrombosis or venous hypertension in the lower extremity, known as the iliac veinIn asymptomatic stage, many subjects were found to have compression of iliac vein in CT examination without the establishment a collateral pathway or venousrelated diseases in the leg, but it may have an effect on the venous reflux
The site of iliac vein compression was localized to the left common iliac vein (LCIV, 178/195, 91.3%), right common iliac vein (RCIV, 54/195, 27.7%), confluence of the inferior vena cava (CIVC, 10/195, 5.1%), left external iliac vein (LEIV, 6/195, 3.1%), confluence of the left common iliac vein (CLCIV, 1/195, 0.5%), and the right external iliac vein (REIV, 1/195, 0.5%)
The compression location of LCIV and RCIV which was caused by the right common iliac artery (RCIA), LCIA or branches of the iliac artery were the mostly reported in anatomical variants of the iliac vein compression syndrome (IVCS) patients [1, 4, 19, 21]

Summary

Introduction

Many subjects were found to have compression of iliac vein in CT examination without the establishment a collateral pathway or venousrelated diseases in the leg, but it may have an effect on the venous reflux. These asymptomatic individuals with long durations of severe compression or previous vascular trauma will often progress into the symptomatic. The purpose of this study was to observe, evaluate and summarize the compression characteristics and degree of stenosis of bilateral iliac vein in asymptomatic individuals without lower extremity diseases by contrast-enhanced CT, and to establish a subdivided compression typing to assist and optimize clinical decision-making

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Discussion

Conclusion