Comparing the efficacy of endovascular treatment for iliac vein compression syndrome with or without acute deep venous thrombosis: A single-center retrospective study

Effectiveness of 2D-DSA and 3D-DSA in the Evaluation of Iliac Vein Stenosis: A Multicenter Prospective Study

PURPOSE

To compare the sensitivity of measuring iliac vein stenosis using two-dimensional digital subtraction angiography (2D-DSA) and three-dimensional digital subtraction angiography (3D-DSA), with multidetector computed tomography venography (MDCTV) as the reference standard.

METHODS

Between January 2020 and January 2023, a total of 103 patients suffered from chronic venous insufficiency symptoms categorized as CEAP Level 3 or above were included from three centers. These patients were admitted to our hospital after abdominal vascular ultrasound and MDCTV positivity. During hospitalization, all patients underwent both 2D-DSA and 3D-DSA procedures simultaneously. Ensure double-blind and rigorous evaluation process when evaluating images. All patients were categorized into two groups based on the degree of CTV stenosis: Group A (50%-70%) and Group B (>70%). Considering the morphology of iliac vein compression, all patients were categorized into three groups: central, lateral, and partial obstruction. Subsequently, the effectiveness analysis was performed for each diagnostic method based on the aforementioned classification.

RESULTS

With MDCTV as the reference standard, in Group A, the sensitivity of 2D-DSA and 3D-DSA is 78.69% and 90.48%, respectively. In Group B, the sensitivity of 2D-DSA and 3D-DSA is 93.44% and 97.62%, respectively. In Group A, the accuracy of 3D-DSA is significantly higher than that of 2D-DSA (p = 0.019). However, there is no statistically significant difference in Group B (p = 0.360). The accuracy rates for central, lateral, and partial obstruction using 2D-DSA are, respectively, 77.55%, 69.70%, and 95.24%. The accuracy rates for central, lateral, and partial obstruction using 3D-DSA are, respectively, 93.88%, 93.94%, and 100%. In central group, the accuracy of 3D-DSA is significantly higher than that of 2D-DSA (p = 0.021). In lateral group, no significant difference was observed between the accuracy obtained by both methods (p = 0.011). Similarly, no significant difference was found in partial obstruction group (p = 1.000). During the angiography procedure using 3D-DSA, a significant reduction was observed in both contrast agent quantity and exposure time (p < 0.05) without any apparent effects on renal function.

CONCLUSION

Regardless of the degree or type of iliac vein stenosis, 3D-DSA exhibits superior sensitivity compared to 2D-DSA for the diagnosis and evaluation of stenosis. Particularly in instances of noncentral stenosis, 3D-DSA outperforms 2D-DSA.Clinical ImpactThis will provide new insights for the clinical diagnosis and treatment of iliac vein compression syndrome (IVCS), significantly enhancing the diagnostic accuracy of IVCS. For clinicians, three-dimensional digital subtraction angiography (3D-DSA)offers a more comprehensive and detailed assessment in clinical practice, leading to more precise diagnosis and treatment of the disease. The efficacy of two-dimensional digital subtraction angiography (2D-DSA) in treating IVCS is significantly compromised without the guidance from computed tomography venography (CTV). We consider that 3D-DSA can replace CTV in both diagnosis and treatment, providing a new diagnostic and therapeutic strategy.

The Long-Term Prognosis of Endovascular Thrombectomy in Patients with Acute Left Iliofemoral Vein Thrombosis Combined with Left Iliac Vein Compression

BACKGROUND

This study investigated the long-term outcomes of different thrombus removal methods in patients with acute left iliofemoral vein thrombosis (IFDVT) accompanied by left iliac vein compression (LIVC).

METHODS

This was a single-center cohort study. 240 patients with acute left-sided IFDVT complicated by LIVC were categorized based on their treatment approach into 2 groups: those receiving anticoagulation alone with no pharmacomechanical catheter-directed thrombolysis applied (No-PCDT group) and those undergoing anticoagulation combined with pharmacomechanical catheter-directed thrombolysis (PCDT group). The PCDT group was further divided into 3 subgroups: anticoagulation combined with percutaneous mechanical thrombectomy (PMT group), anticoagulation combined with catheter-directed thrombolysis (CDT group), and anticoagulation combined with both PMT and catheter-directed thrombolysis (PMT + CDT group). The incidence of postthrombotic syndrome (PTS) was assessed using Villalta scores and Venous Clinical Severity Scores (VCSS). Patients were followed up for 24 months to compare long-term outcomes.

RESULTS

The No-PCDT group consisted of 123 individuals, while the PCDT group comprised 117, with 36 in the CDT subgroup, 41 in the PMT subgroup, and 40 in the PMT + CDT subgroup. The follow-up period ranged from 3 to 24 months. The PCDT group was associated with a reduced incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or presence of ulcer: 22% PCDT vs. 39% No-PCDT; odds ratio [OR], 0.446; 95% confidence interval [CI], 0.253-0.787; P = 0.005; and VCSS ≥ 4: 22% PCDT vs. 34% No-PCDT; OR, 0.551; 95% CI, 0.311-0.978; P = 0.042). Among the 3 subgroups of PCDT cohort, compared to the CDT group, the PMT group showed a decreased incidence of PTS and a lower risk of high VCSS (Villalta scale ≥ 5 or ulcer: 12% PMT vs. 39% CDT; OR, 0.218; 95% CI, 0.069-0.690; P = 0.010; and VCSS ≥ 4: 12% PMT vs. 36% CDT; OR, 0.246; 95% CI, 0.077-0.781; P = 0.017). The PMT + CDT group also demonstrated a reduced incidence of PTS (18% PMT + CDT vs. 39% CDT; OR, 0.333; 95% CI, 0.116-0.958; P = 0.041) compared to the CDT group, but did not show a significant reduction in the risk of high VCSS (20% PMT + CDT vs. 36% CDT; P = 0.121). Compared to the PMT group, the PMT + CDT group did not significantly reduce the incidence of PTS (12% PMT vs. 18% PMT + CDT; P = 0.504) or the rate of high VCSS (12% PMT vs. 20% PMT + CDT; P = 0.343).

CONCLUSIONS

In patients with acute left IFDVT complicated by LIVC, PMT may serve as a more efficacious method for thrombus removal compared to CDT and combined PMT + CDT in reducing both the incidence of PTS and the risk of high VCSS.

Efficacy Analysis of Endovascular Therapy for Nonthrombotic Iliac Vein Compression Syndrome Combined with Chronic Venous Insufficiency

Purpose

This research is aimed at elucidating the clinical efficacy of balloon dilatation (BD) plus stent implantation for nonthrombotic iliac vein compression syndrome (NIVCS) combined with chronic venous insufficiency (CVI) in different compression positions.

Methods

Sixty-five NIVCS patients comorbid with CVI admitted between December 2015 and April 2020 were selected and assigned to two groups according to different iliac vein compression positions. Both groups of patients received iliac vein BD + stent implantation, with the difference lying in that the tip of the stent was inserted 0.5-1 cm into the inferior vena cava (IVC) in the experimental group versus 2-3 cm in the control group. The technical success rate, the postoperative venous clinical severity score (VCSS), and the incidence of complications were compared.

Results

The technical success rate of both groups was 100%. Patients were followed up for 12-36 months (average: 25.5 ± 6.2). Decreases in VCSS were observed in both cohorts at 3, 6, 12, 24, and 36 months postoperatively compared with the preoperative scores, but with no statistical difference. There was no death, nor related complications such as restenosis and lower limb deep vein thrombosis during the follow-up period, with no statistical difference in the incidence of complications between groups.

Conclusions

BD + stent implantation is a safe and effective treatment for NIVCS with few complications and remarkable short-term and medium-term effects.