Vol 21, No 1-2 (2019)
Research paper
Published online: 2021-03-04
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Left iliac vein compression in Leriche syndrome patients — a potential link between aorto-iliac occlusive disease and DVT occurrence?

Tomasz Urbanek, Bartosz Kończyk, Monika Kasperczyk, Wacław Kuczmik
Chirurgia Polska 2019;21(1-2):20-26.

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Vol 21, No 1-2 (2019)
Original articles
Published online: 2021-03-04

Abstract

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.

Abstract

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.

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Keywords

atherosclerosis; deep vein thrombosis; compression syndrome; iliac veins

About this article
Title

Left iliac vein compression in Leriche syndrome patients — a potential link between aorto-iliac occlusive disease and DVT occurrence?

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 21, No 1-2 (2019)

Article type

Research paper

Pages

20-26

Published online

2021-03-04

Bibliographic record

Chirurgia Polska 2019;21(1-2):20-26.

Keywords

atherosclerosis
deep vein thrombosis
compression syndrome
iliac veins

Authors

Tomasz Urbanek
Bartosz Kończyk
Monika Kasperczyk
Wacław Kuczmik

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