[MO-40] Iliac vein compression syndrome- evidence and endoluminal treatment
Introduction
The clinical presentation of Iliac vein compression syndrome (IVCS) was first reported in 1965 by Cockett et Thomas. The pathoetiology is that the left iliac vein being compressed by the overriding right iliac artery ensuing iliac venous outflow obstruction with the consequence of venous hypertension in the pelvis and lower limb. The treatment of IVCS had been surgical until 1995 when iliac vein stenting for May-Thurner syndrome was introduced by Dr. Berger. The diagnosis of IVCS should be established by imaging study .
Methods
Between Jan 2008 and Dec 31 2017, 1025 consecutive patients (age ranging from 14 to 86 with median age of 56) with clinical diagnosis of pelvic venous compression(PVC) were retrospectively reviewed. The diagnosis was established by detailed history, clinical examination, non-invasive vascular test and vascular sonogram and further verified by the iliac venogram with multi-detector computed tomography (MDCT). The demonstrated venous pathology includes radiographic evidence of occlusion, stenosis with venous collaterals and other anatomical deformities. The operation includes angioplastic balloon dilatation with placement of metallic stents in different configuration.
Results
Three types of stenting applied; unilateral iliac vein stenting 259/1000(25.9 %), appositional bilateral iliac vein stenting 246/1000 (24.6 %) and bilateral kissing stents as original procedure 386/1000 (38.6%). Totally 2048 stents deployed. Technical success rate 99.8 %. Patency rate at 3 months, 6 months and 12months were 98.3%, 96.6 % and 94.7 % respectively. Clinical symptoms improved significantly in terms of pain, swelling ,soft tissue induration and function. There was no surgical mortality and the morbidity was minimal.
Conclusions
IVCS presenting with phlebolymphedema and other various symptoms related to venous outflow obstruction is ameliorable with endoluminal treatment by placement of metallic stents. The procedure is safe and effective. Long term follow-up is necessary to prove the value of the procedure.
The clinical presentation of Iliac vein compression syndrome (IVCS) was first reported in 1965 by Cockett et Thomas. The pathoetiology is that the left iliac vein being compressed by the overriding right iliac artery ensuing iliac venous outflow obstruction with the consequence of venous hypertension in the pelvis and lower limb. The treatment of IVCS had been surgical until 1995 when iliac vein stenting for May-Thurner syndrome was introduced by Dr. Berger. The diagnosis of IVCS should be established by imaging study .
Methods
Between Jan 2008 and Dec 31 2017, 1025 consecutive patients (age ranging from 14 to 86 with median age of 56) with clinical diagnosis of pelvic venous compression(PVC) were retrospectively reviewed. The diagnosis was established by detailed history, clinical examination, non-invasive vascular test and vascular sonogram and further verified by the iliac venogram with multi-detector computed tomography (MDCT). The demonstrated venous pathology includes radiographic evidence of occlusion, stenosis with venous collaterals and other anatomical deformities. The operation includes angioplastic balloon dilatation with placement of metallic stents in different configuration.
Results
Three types of stenting applied; unilateral iliac vein stenting 259/1000(25.9 %), appositional bilateral iliac vein stenting 246/1000 (24.6 %) and bilateral kissing stents as original procedure 386/1000 (38.6%). Totally 2048 stents deployed. Technical success rate 99.8 %. Patency rate at 3 months, 6 months and 12months were 98.3%, 96.6 % and 94.7 % respectively. Clinical symptoms improved significantly in terms of pain, swelling ,soft tissue induration and function. There was no surgical mortality and the morbidity was minimal.
Conclusions
IVCS presenting with phlebolymphedema and other various symptoms related to venous outflow obstruction is ameliorable with endoluminal treatment by placement of metallic stents. The procedure is safe and effective. Long term follow-up is necessary to prove the value of the procedure.