JVSVL: Compression may promote, but not cause, iliac DVT

SVS: Compression may promote, but not cause, iliac DVT LEFT ILIAC VEIN COMPRESSION IS NOT ASSOCIATED WITH INFRAINGUINAL DVT BUT IS ASSOCIATED WITH ILIAC VEIN INVOLVEMENT. Journal of Vascular Surgery: Venous and Lymphatic Disorders, November 2018.

CHICAGO, Illinois, November 2018 – A recent study of a large series of patients with iliofemoral deep venous thrombosis (DVT) from Nanchang University suggests that, in general, compression itself is not the precipitating factor in iliac DVT; rather, it is the promoter of iliac DVT should infra-inguinal thrombosis occur.

Research to date has been unclear on whether compression lessens the chance of lower extremity DVT. Previous research investigating the relationship between iliac vein compression and DVT has been inconclusive. One study suggesting a strong correlation has not been fully corroborated by others.

Iliofemoral deep vein thrombosis can be devastating acutely, in the form of phlegmasia, and chronically, with a high incidence of post-thrombotic syndrome. Understanding the etiology of this problem is potentially helpful in prevention. Particularly on the left side, compression of the iliac veins results in a spectrum of symptoms, including swelling, varicose veins and DVT.

As reported in the November edition of the Journal of Vascular Surgery: Venous and Lymphatic Disorders, researchers from Nanchang University led by Feng Chen, Doc, PhD, performed a single center, retrospective study of 278 patients with left sided lower extremity DVT. The patients were divided into those with iliac DVT (228) versus infra-inguinal DVT alone (50) and compared with 232 control patients without DVT.

In studying the relationship of iliac vein compression found on CT imaging with DVT, the key findings of this study revealed the percentage of significant compression in patients:

• With iliac DVT: 75%
• With infra-inguinal DVT: 45%
• No DVT: 53%

Most important, iliac vein compression was associated with iliac (1.88 odds ratio) but not infra-inguinal DVT (0.89 odds ratio).

“Given the high incidence of vein compression in our patient population, yet the relatively low incidence of DVT in general, the presence of this anatomic finding alone [does] not likely result in left-sided DVT,” states Dr. Chen. “This data suggests that, in general, compression itself is not the precipitating factor in iliac DVT; rather, it is the promoter of iliac DVT should infra-inguinal thrombosis occur.”

Left iliac DVT patients had more severe LIV compression than left infrainguinal DVT patients did. LIV compression was not associated with development of left infrainguinal DVT, but it did correlate with the presence of left-sided DVT with iliac vein involvement. Dr. Chen suggests that “The clinical significance of this study is that endovascular treatment (angioplasty and stent) is inappropriate for those with iliac compression solely to prevent DVT.”

This large, image-based research furthers our understanding of the consequences of iliac vein compression revealing that its presence is not associated with infra-inguinal DVT.

This article will be open source through Dec. 31 at: http://vsweb.org/JVSVL-IlliacVein