Left iliac vein compression in Leriche syndrome patients — a potential link between aorto-iliac occlusive disease and DVT occurrence?
Streszczenie
Introduction: One of the important anatomical conditions, which can potentially limit the lower leg venous outflow, is the compression of the left iliac vein in its proximal segment by the right iliac artery. Several studies suggest the relatively high occurrence of this pathology, also in the asymptomatic patients, with a much higher prevalence in the patients diagnosed with proximal left leg DVT episode. The anatomical locations of the aortic bifurcation and inferior vena confluence suggest the possibility of other vascular pathologies causing venous outflow disturbances in this region such as an aneurysm or atherosclerotic plaques. In the study, the possible compression of the left iliac vein in patients with Leriche syndrome was investigated.
Material and methods: 40 patients with Leriche syndrome and symptomatic peripheral atherosclerosis obliterative disease were evaluated. The median age of the patients was 65 yrs. (from 53 to 76) and all the patients underwent CT-angio of the aorta and iliac arteries. The analysis assessed the diameter of the left and right iliac artery, as well as the diameter of the common left and right iliac vein. The left common iliac vein (CIV) stenosis was evaluated by comparing the CIV vein diameter at the place of the possible stenosis with the contralateral common iliac vein diameter at the same level as well as with the ipsilateral common iliac vein diameter distally to the stenosis.
Results: The median diameter of the left common iliac vein at the pressure site in the study population was 7.42 mm (range 3.9–9.69 mm), with a mean of 12.11± 2.35 mm (12.03 ± 2.7 for men and 11.8 ± 2.99 females) on the right side. The mean degree of stenosis of the left iliac vein was 46% for the entire population and the stenosis above 50% was diagnosed in 45% of the studied population (with the prevalence of the stenosis of 70% or more in 5% only). The analysis of the relationship between the presence of stenotic changes or obstruction in the right common iliac artery and the presence of significant stenosis or obstruction of the left iliac vein showed no significant correlation between the degree of left CIV stenosis and the severity of changes in the right common iliac artery. There was no significant difference in the incidence of stenosis of above 50% between the male and female population with atherosclerotic lesions.
Conclusion: The asymptomatic left common iliac vein stenosis can be found in a significant number of patients with atherosclerotic changes in the aortic bifurcation and iliac arteries. Due to the complex process of arterial wall remodelling in patients with atherosclerosis including plaque growth, possible vessel widening, and elongation, the clinical importance of these observations should be investigated in further studies.
Słowa kluczowe: atherosclerosisdeep vein thrombosiscompression syndromeiliac veins
Referencje
- Malone PC, Agutter PS, Malone PC, et al. The aetiology of deep venous thrombosis. QJM. 2006; 99(9): 581–593.
- Bulger CM, Jacobs C, Patel NH. Epidemiology of acute deep vein thrombosis. Tech Vasc Interv Radiol. 2004; 7(2): 50–54.
- Kearon C. Epidemiology of venous thromboembolism. Semin Vasc Med. 2001; 1(1): 7–26.
- Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol. 2007; 44(2): 62–69.
- Liddell RP, Evans NS. May-Thurner syndrome. Vasc Med. 2018; 23(5): 493–496.
- Harbin MM, Lutsey PL. May-Thurner syndrome: History of understanding and need for defining population prevalence. J Thromb Haemost. 2020; 18(3): 534–542.
- MAY R, THURNER J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957; 8(5): 419–427.
- Sermsathanasawadi N, Pruekprasert K, Pitaksantayothin W, et al. Prevalence, risk factors, and evaluation of iliocaval obstruction in advanced chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2019; 7(3): 441–447.
- Marston W, Fish D, Unger J, et al. Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers. J Vasc Surg. 2011; 53(5): 1303–1308.
- Kalu S, Shah P, Natarajan A, et al. May-thurner syndrome: a case report and review of the literature. Case Rep Vasc Med. 2013; 2013: 740182.
- Harbin MM, Lutsey PL. May-Thurner syndrome: History of understanding and need for defining population prevalence. J Thromb Haemost. 2020; 18(3): 534–542.
- Mousa AY, AbuRahma AF. May-Thurner syndrome: update and review. Ann Vasc Surg. 2013; 27(7): 984–995.
- Ikeda A. Inferior Vena Cava Compression Caused by a Retroperitoneal Hematoma Following an Abdominal Aortic Aneurysm Rupture. Ann Vasc Dis. 2019; 12(1): 87–90.
- Moore RD, Rutter ED, Zapko DR, et al. Abdominal aortic aneurysm with inferior vena cava compression in association with deep venous thrombosis. Am J Med Sci. 2013; 346(6): 521–522.
- Moreland NC, Ujiki M, Matsumura JS, et al. Decreased incidence of left common iliac vein compression in patients with abdominal aortic aneurysms. J Vasc Surg. 2006; 44(3): 595–600.
- Walsh JJ, Williams LR, Driscoll JL, et al. Vein compression by arterial aneurysms. J Vasc Surg. 1988; 8(4): 465–469.
- Secil M, Sarisoy HT, Hazan E, et al. Iliac artery aneurysm presenting with lower extremity deep vein thrombosis. J Emerg Med. 2003; 24(1): 65–67.
- Venturini L, Grande R, Sapienza P. A Rare Presentation of an Isolated Internal Iliac Artery Aneurysm: Report of a Case and Literature Review. Vasc Endovascular Surg. 2017; 51(5): 320–323.
- Khang NC, Hanif H, Zainal Ariffin A. Rare cause of lower limb deep venous thrombosis: a case report. Med J Malaysia. 2014; 69(3): 144–145.
- Neglén P, Thrasher TL, Raju S. Venous outflow obstruction: An underestimated contributor to chronic venous disease. J Vasc Surg. 2003; 38(5): 879–885.
- Raju S, Neglen P. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg. 2006; 44(1): 136–43; discussion 144.
- Labropoulos N, Borge M, Pierce K, et al. Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg. 2007; 46(1): 101–107.
- Gagne PJ, Gasparis A, Black S, et al. Analysis of threshold stenosis by multiplanar venogram and intravascular ultrasound examination for predicting clinical improvement after iliofemoral vein stenting in the VIDIO trial. J Vasc Surg Venous Lymphat Disord. 2018; 6(1): 48–56.e1.
- Nazzal M, El-Fedaly M, Kazan V, et al. Incidence and clinical significance of iliac vein compression. Vascular. 2015; 23(4): 337–343.
- Kibbe MR, Ujiki M, Goodwin AL, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004; 39(5): 937–943.
- Brinegar KN, Sheth RA, Khademhosseini A, et al. Iliac vein compression syndrome: Clinical, imaging and pathologic findings. World J Radiol. 2015; 7(11): 375–381.
- Smedby O, Bergstrand L. Tortuosity and atherosclerosis in the femoral artery: what is cause and what is effect? Ann Biomed Eng. 1996; 24(4): 474–480.
- Milan M, Vedovetto V, Bilora F, et al. Further evidence in support of the association between venous thrombosis and atherosclerosis: a case-control study. Thromb Res. 2014; 134(5): 1028–1031.
- Prandoni P, Ciammaichella M, Mumoli N, et al. Veritas Investigators. An association between residual vein thrombosis and subclinical atherosclerosis: Cross-sectional study. Thromb Res. 2017; 157: 16–19.
- Prandoni P, Ghirarduzzi A, Prins MH, et al. Venous thromboembolism and the risk of subsequent symptomatic atherosclerosis. J Thromb Haemost. 2006; 4(9): 1891–1896.
- Mi Y, Yan S, Lu Y, et al. Venous thromboembolism has the same risk factors as atherosclerosis: A PRISMA-compliant systemic review and meta-analysis. Medicine (Baltimore). 2016; 95(32): e4495.
- Gaertner S, Cordeanu EM, Mirea C, et al. Increased risk and severity of unprovoked venous thromboembolism with clustering cardiovascular risk factors for atherosclerosis: Results of the REMOTEV registry. Int J Cardiol. 2018; 252: 169–174.
- Green D. Risk of future arterial cardiovascular events in patients with idiopathic venous thromboembolism. Hematology Am Soc Hematol Educ Program. 2009: 259–266.
- Bilora F, Ceresa M, Milan M, et al. The impact of deep vein thrombosis on the risk of subsequent cardiovascular events: a 14-year follow-up study. Int Angiol. 2017; 36(2): 156–159.
- Pasha SM, Tan M, van Rees Vellinga TFD, et al. Risk of atherothrombotic events in patients after proximal deep-vein thrombosis. Blood Coagul Fibrinolysis. 2016; 27(1): 13–18.
- Bova C, Marchiori A, Noto A, et al. Incidence of arterial cardiovascular events in patients with idiopathic venous thromboembolism. A retrospective cohort study. Thromb Haemost. 2006; 96(2): 132–136.
- Prandoni P, Piovella C, Pesavento R. Venous thromboembolism and arterial complications. Semin Respir Crit Care Med. 2012; 33(2): 205–210.
- Folsom AR, Lutsey PL, Heckbert SR, et al. Longitudinal increases in blood biomarkers of inflammation or cardiovascular disease and the incidence of venous thromboembolism. J Thromb Haemost. 2018; 16(10): 1964–1972.
- Riva N, Donadini MP, Ageno W. Epidemiology and pathophysiology of venous thromboembolism: similarities with atherothrombosis and the role of inflammation. Thromb Haemost. 2015; 113(6): 1176–1183.
- Prandoni P. Is there a link between venous and arterial thrombosis? A reappraisal. Intern Emerg Med. 2020; 15(1): 33–36.
- Ageno W, Prandoni P, Romualdi E, et al. The metabolic syndrome and the risk of venous thrombosis: a case-control study. J Thromb Haemost. 2006; 4(9): 1914–1918.
- Wattanakit K, Lutsey PL, Bell EJ, et al. Association between cardiovascular disease risk factors and occurrence of venous thromboembolism. A time-dependent analysis. Thromb Haemost. 2012; 108(3): 508–515.
- Piazza G, Goldhaber SZ, Lessard DM, et al. Venous thromboembolism in patients with symptomatic atherosclerosis. Thromb Haemost. 2011; 106(6): 1095–1102.
- Prasad M, McBane R, Reriani M, et al. Coronary endothelial dysfunction is associated with increased risk of venous thromboembolism. Thromb Res. 2016; 139: 17–21.
