Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers

Abstract

ICVO is a frequent and underappreciated contributor to venous hypertension in patients with venous leg ulcers. Women and patients with a history of DVT or duplex scan-diagnosed deep venous reflux (DVR) have a higher incidence of outflow obstruction and should be routinely studied with CT or MR venography to allow correction in this high-risk group of patients.

Venous Pressure Gradient: It’s Role in Diagnosis and Treatment of Steno-Obstructions of Deep Venous System

“…In symptomatic patients, recanalisation of thrombosis veins is incomplete and the collateral circulation is inadequate resulting in distal venous hypertension with lower extremity swelling, pain worsened after ambulation, venous ulcers and others clinical manifestations of post thrombotic syndrome. Although venous outflow obstructions of the lower extremity may involve the entire venous system, iliocaval venous steno-obstructions, more than peripheral obstructions, play an important role in determining the most severe symptoms of venous insufficiency [1][2][3][4][5][6].…”

“…Moreover in the last decade a few authors describe the much broaded disease profile that emerged with the use of IVUS for diagnosis, finding the incidence of no thrombotic iliac vein outflow obstructions to be very high in symptomatic CVI cases; it has been known that the etiology of venous steno-obstructions can be primary (nonthrombotic) or secondary (post-thrombotic) with equal prevalence estimated in patients with chronic venous disease [2][3][4][5][6][7]. It was already known that primary forms are related to compression of the left iliac common vein, anatomically near to the hypogastric artery bifurcation, with presence of webs or membranes resulting from traumatic injury caused by pulsations of the artery [7,8].…”

“…Endovascular treatment involving the use of iliac venous PTA and stenting has become gold standard treatment [1][2][3][4][5][6][7][8][9][10][11].…”

“…The diagnosis is based both on clinical signs and symptoms and on radiological assessment of morphological venous outflow such as trans-femoral phlebography, Intravascular Ultrasound (IVUS), CT and RM venography [5,11,13].…”

Ultrassonografia vascular comparada à intravascular no diagnóstico das obstruções venosas ilíacas em portadores de insuficiência venosa crônica

“…Marston et al 8 . Com o uso do UI e outras técnicas de imagem modernas, soubemos que a obstrução da veia ilíaca está, frequentemente presente, e pode ser demonstrada nos pacientes com IVC avançada, ou em associação com o refluxo venoso.…”