Analysis of iliac vein stenosis and relevant to factors in crowds without lower extremity venous disease and symptoms and patients with lower extremity varicose vein: a historical cohort study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZUO Xiangyi , LI Huanhuan , YAO Guoqing , ZHAO Yu ,  WANG Xuehu

Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

WANG Xuehu, Email: wangxuehu@hospital.cqmu.edu.cn

Keywords：

iliac vein compression syndrome; varicose vein; compression degree; imaging; evaluation method

DOI：

10.7507/1007-9424.202210065

Video：

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Objective To understand the prevalence of iliac vein stenosis in crowds without lower extremityvenous disease and symptoms (abbreviated as asymptomatic crowd) and patients with lower extremity varicose vein and analyze relevant to factors of iliac vein stenosis. Methods According to the inclusion and exclusion criteria, the CT imaging data and clinical informations of objects in the department of vascular surgery, the First Affiliated Hospital of Chongqing Medical University from 2020 to 2021 were collected. The objects included the patients with lower extremity varicose vein in the department of vascular surgery of this hospital and asymptomatic crowds in the physical examination center of this hospital. The occurrence of iliac vein stenosis of the objects was compared and the relevant to risk factors affecting the occurrence of iliac vein stenosis were analyzed. Results A total of 268 subjects who met the criteria were included in this study, the iliac vein stenosis was occurred in 63 (23.5%) subjects. there were 162 asymptomatic crowds and 106 patients with lower extremity varicose vein. The incidence of iliac vein stenosis was higher in the patients with lower extremity varicose vein than that in the asymptomatic crowds [36.8% (39/106) versus 14.8% (24/162), χ²=17.212, P<0.001]. The results of multivariate logistic regression analysis showed that the female crowds had a higher risk of iliac vein stenosis as compared with the male crowds [OR=3.131, 95%CI (1.188, 8.257), P=0.021] and the crowds with higher body mass index (BMI) had a lower risk of iliac vein stenosis [OR=0.802, 95%CI (0.666, 0.966), P=0.020] in the asymptomatic crowds, as well as the risk of iliac vein stenosis was decreased in the older patients with lower extremity varicose vein [OR=0.946, 95%CI (0.901, 0.993), P=0.026]. Conclusion From the results of this study, the incidence of iliac vein stenosis is not low, and the incidence rate of patient with lower extremity varicose vein is higher than that of asymptomatic crowd, and there may be associated with gender, age, or BMI.

Citation： ZUO Xiangyi, LI Huanhuan, YAO Guoqing, ZHAO Yu, WANG Xuehu. Analysis of iliac vein stenosis and relevant to factors in crowds without lower extremity venous disease and symptoms and patients with lower extremity varicose vein: a historical cohort study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(3): 315-319. doi: 10.7507/1007-9424.202210065 Copy

1.	May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology, 1957, 8(5): 419-427.
2.	Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg, 1965, 52(10): 816-821.
3.	McDermott S, Oliveira G, Ergül E, et al. May-Thurner syndrome: can it be diagnosed by a single MR venography study? Diagn Interv Radiol, 2013, 19(1): 44-48.
4.	Goldman RE, Arendt VA, Kothary N, et al. Endovascular management of May-Thurner syndrome in adolescents: a single-center experience. J Vasc Interv Radiol, 2017, 28(1): 71-77.
5.	Cheng L, Zhao H, Zhang FX. Iliac vein compression syndrome in an asymptomatic patient population: a prospective study. Chin Med J (Engl), 2017, 130(11): 1269-1275.
6.	Wolpert LM, Rahmani O, Stein B, et al. Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovascular Surg, 2002, 36(1): 51-57.
7.	Liu Z, Gao N, Shen L, et al. Endovascular treatment for symptomatic iliac vein compression syndrome: a prospective consecutive series of 48 patients. Ann Vasc Surg, 2014, 28(3): 695-704.
8.	Yang L, Liu J, Cai H, et al. The clinical outcome of a one-stop procedure for patients with iliac vein compression combined with varicose veins. J Vasc Surg Venous Lymphat Disord, 2018, 6(6): 696-701.
9.	吾布力卡斯木·吾拉木, 王浴锋, 陈秋梨, 等. 无症状髂静脉压迫的发生率及其临床特征. 中华血管外科杂志, 2021, 6(1): 28-31.
10.	Kibbe MR, Ujiki M, Goodwin AL, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg, 2004, 39(5): 937-943.
11.	Carr S, Chan K, Rosenberg J, et al. Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis. J Vasc Interv Radiol, 2012, 23(11): 1467-1472.
12.	井元虎, 陈兆雷, 孙元, 等. 髂静脉受压综合征狭窄度的评估策略. 中华灾害救援医学, 2018, 6(5): 296-300.
13.	Wu MK, Luo XY, Zhang FX. Incidence and risk factors of deep venous thrombosis in asymptomatic iliac vein compression: a prospective cohort study. Chin Med J (Engl), 2016, 129(18): 2149-2152.
14.	Harbin MM, Lutsey PL. May-Thurner syndrome: history of understanding and need for defining population prevalence. J Thromb Haemost, 2020, 18(3): 534-542.
15.	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, 2022, 46(5): 722-728.
16.	Tseng YH, Chen CW, Wong MY, et al. Reduced external iliac venous blood flow rate is associated with asymptomatic compression of the common iliac veins. Medicina (Kaunas), 2021, 57(8): 835. doi: 10.3390/medicina57080835.
17.	Butros SR, Liu R, Oliveira GR, et al. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol, 2013, 86(1030): 20130284. doi: 10.1259/bjr.20130284.
18.	Rison RA, Helfgott MD. Acute paradoxical embolic cerebral ischemia secondary to possible May-Thurner syndrome and an atrial septal defect: a case report. J Med Case Rep, 2013, 7: 172. doi: 10.1186/1752-1947-7-172.
19.	Peters M, Syed RK, Katz M, et al. May-Thurner syndrome: a not so uncommon cause of a common condition. Proc (Bayl Univ Med Cent), 2012, 25(3): 231-233.
20.	Budnur SC, Singh B, Mahadevappa NC, et al. Endovascular treatment of iliac vein compression syndrome (May-Thurner). Cardiovasc Interv Ther, 2013, 28(1): 101-105.
21.	Heller JA, Evans NS. Varicose veins. Vasc Med, 2015, 20(1): 88-90.
22.	Dzieciuchowicz Ł, Krzyżański R, Kruszyna Ł, et al. Prevalence of non-thrombotic iliac vein lesions in patients with unilateral primary varicose veins. Eur J Vasc Endovasc Surg, 2016, 51(3): 429-433.
23.	Oguzkurt L, Ozkan U, Ulusan S, et al. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol, 2008, 19(3): 366-370.
24.	Passman MA, McLafferty RB, Lentz MF, et al. Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program. J Vasc Surg, 2011, 54(6 Suppl): 2S-9S. doi: 10.1016/j.jvs.2011.05.117.
25.	Ortega MA, Fraile-Martínez O, García-Montero C, et al. Understanding chronic venous disease: a critical overview of its pathophysiology and medical management. J Clin Med, 2021, 10(15): 3239. doi: 10.3390/jcm10153239.
26.	Li X, Zhang H, Niu L, et al. Clinical outcomes of radiofrequency ablation for patients with varicose veins of the lower extremities combined with grade Ⅱ iliac vein compression. J Vasc Surg Venous Lymphat Disord, 2021, 9(3): 676-682.

1. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology, 1957, 8(5): 419-427.
2. Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg, 1965, 52(10): 816-821.
3. McDermott S, Oliveira G, Ergül E, et al. May-Thurner syndrome: can it be diagnosed by a single MR venography study? Diagn Interv Radiol, 2013, 19(1): 44-48.
4. Goldman RE, Arendt VA, Kothary N, et al. Endovascular management of May-Thurner syndrome in adolescents: a single-center experience. J Vasc Interv Radiol, 2017, 28(1): 71-77.
5. Cheng L, Zhao H, Zhang FX. Iliac vein compression syndrome in an asymptomatic patient population: a prospective study. Chin Med J (Engl), 2017, 130(11): 1269-1275.
6. Wolpert LM, Rahmani O, Stein B, et al. Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovascular Surg, 2002, 36(1): 51-57.
7. Liu Z, Gao N, Shen L, et al. Endovascular treatment for symptomatic iliac vein compression syndrome: a prospective consecutive series of 48 patients. Ann Vasc Surg, 2014, 28(3): 695-704.
8. Yang L, Liu J, Cai H, et al. The clinical outcome of a one-stop procedure for patients with iliac vein compression combined with varicose veins. J Vasc Surg Venous Lymphat Disord, 2018, 6(6): 696-701.
9. 吾布力卡斯木·吾拉木, 王浴锋, 陈秋梨, 等. 无症状髂静脉压迫的发生率及其临床特征. 中华血管外科杂志, 2021, 6(1): 28-31.
10. Kibbe MR, Ujiki M, Goodwin AL, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg, 2004, 39(5): 937-943.
11. Carr S, Chan K, Rosenberg J, et al. Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis. J Vasc Interv Radiol, 2012, 23(11): 1467-1472.
12. 井元虎, 陈兆雷, 孙元, 等. 髂静脉受压综合征狭窄度的评估策略. 中华灾害救援医学, 2018, 6(5): 296-300.
13. Wu MK, Luo XY, Zhang FX. Incidence and risk factors of deep venous thrombosis in asymptomatic iliac vein compression: a prospective cohort study. Chin Med J (Engl), 2016, 129(18): 2149-2152.
14. Harbin MM, Lutsey PL. May-Thurner syndrome: history of understanding and need for defining population prevalence. J Thromb Haemost, 2020, 18(3): 534-542.
15. 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, 2022, 46(5): 722-728.
16. Tseng YH, Chen CW, Wong MY, et al. Reduced external iliac venous blood flow rate is associated with asymptomatic compression of the common iliac veins. Medicina (Kaunas), 2021, 57(8): 835. doi: 10.3390/medicina57080835.
17. Butros SR, Liu R, Oliveira GR, et al. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol, 2013, 86(1030): 20130284. doi: 10.1259/bjr.20130284.
18. Rison RA, Helfgott MD. Acute paradoxical embolic cerebral ischemia secondary to possible May-Thurner syndrome and an atrial septal defect: a case report. J Med Case Rep, 2013, 7: 172. doi: 10.1186/1752-1947-7-172.
19. Peters M, Syed RK, Katz M, et al. May-Thurner syndrome: a not so uncommon cause of a common condition. Proc (Bayl Univ Med Cent), 2012, 25(3): 231-233.
20. Budnur SC, Singh B, Mahadevappa NC, et al. Endovascular treatment of iliac vein compression syndrome (May-Thurner). Cardiovasc Interv Ther, 2013, 28(1): 101-105.
21. Heller JA, Evans NS. Varicose veins. Vasc Med, 2015, 20(1): 88-90.
22. Dzieciuchowicz Ł, Krzyżański R, Kruszyna Ł, et al. Prevalence of non-thrombotic iliac vein lesions in patients with unilateral primary varicose veins. Eur J Vasc Endovasc Surg, 2016, 51(3): 429-433.
23. Oguzkurt L, Ozkan U, Ulusan S, et al. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol, 2008, 19(3): 366-370.
24. Passman MA, McLafferty RB, Lentz MF, et al. Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program. J Vasc Surg, 2011, 54(6 Suppl): 2S-9S. doi: 10.1016/j.jvs.2011.05.117.
25. Ortega MA, Fraile-Martínez O, García-Montero C, et al. Understanding chronic venous disease: a critical overview of its pathophysiology and medical management. J Clin Med, 2021, 10(15): 3239. doi: 10.3390/jcm10153239.
26. Li X, Zhang H, Niu L, et al. Clinical outcomes of radiofrequency ablation for patients with varicose veins of the lower extremities combined with grade Ⅱ iliac vein compression. J Vasc Surg Venous Lymphat Disord, 2021, 9(3): 676-682.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of iliac vein stenosis and relevant to factors in crowds without lower extremity venous disease and symptoms and patients with lower extremity varicose vein: a historical cohort study

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