Diagnosis And Endovascular Treatment Of Nonthrombotic Iliac Vein Compression Syndrome

Objective:Nonthrombotic iliac venous compression syndrome(NIVCS),with atypical symptoms,occurs in a high incidence.the clinicians do not pay enough attention to it even nowadays, so the diagnosis rate is still low, this trend leds to repeated diagnosis and treatment with lower limb venous diseases.We should understand it fully, diagnosis it early and treat it equitable,only in this way can reduce the harm. We take a retrospective analysis research to discuss a method to diagnosis earlier and treated individually.Methods:Collecting the clinical data of 24 cases with NIVCS, Screening of 496 patients with lower extremity venous disease inspection,diagnosised and treated in our department from January 2012 to January 2015. Their symptoms are not typical,6 cases of them are varicose veins of lower limb,1 among the 6 cases is combined with superficial thrombophebitis,6 patients with unidentified cause of lower limb pain,5 cases with recurrence of varicose veins,3 cases with recurrent lower limb skin eczema,and 2 cases with recurrent ulcer.All of the cases do not contain deep vein thrombosis (DVT), pregnancy, and pelvic tumors, etc. Heart and kidney multi-organ diseases are not contained too.All of the patients were checked with color doppler(CDU) at first,and 13 cases have positive performance,then they were all diagnosised by lower extremity venous imaging.4 cases accepted conservative treatment with the iliac veins’ stenosis less than 50%.5 cases accepted simply percutaneous transluminal angioplasty(PTA) treatment,15 cases accepted PTA and stent.All of them accept regular anticoagulation,and they obtain recent and median follow-up observations,so as to acquaint with the stent patency rate, now the processes of diagnosis and treatment were retrospectively analyzed.Results:There were 24 NIVCS patients confirmed in our department, the detection rate was 4.8% (24/496).4 cases with the iliac vein stenosis below 50% acquired mere PTA,2 cases of them associated with left lower varicose veins were underwent surgery treatment,1 case acquired foam sclerotherapy injection.All the 4 cases wear medical elastic stockings all day long. After a year’s follow-up,there is no veins relapse, and the limb swelling disappeared.2 patients among the 5 patients who underwent mere PTA were with recurrent swelling of lower limbs, the symptom significantly reduced 1 month after the operation; 1 case combined with skin pigmentation symptoms,treated for a long time,the symptoms disappeared 12 months after the operation,1 of the 3 patients who associated with left lower varicose veins were underwent surgery treatment. The 15 cases of PTA and stent group:2 patients had left leg ulcers, with the help of 1 year’s anti-inflammatory treatment,the ulcer is scabby and then healing,2 cases with leg eczemaand and itchy cured,2 cases of lower limb swelling decreased significantly, but there was slight swelling in 1 cases,7 patients who associated with left lower varicose veins were underwent surgery treatment.1 patient who stopped warfarin by themselves 3 months after the operation and finally got the stent thrombosis, then it was recanalizated after catheter- thrombolysis. There was no death, no stent shift,and no iliac vein rupture during the treatment.The patency rate of all the 20 cases was 100%,we reviewed the 15 patients with PTA and Stent 3 months after the operation,the patency rate was 93.3% by anterograde venography.The two groups of patients, who received cavity treatment 3 months after the treatment, checked with anterograde venography, the iliac vein restenosis rate were improved, the two groups had no statistical significance, But after the treatment of 12-34 months,3 patients of the mere PTA group,whose iliac vein s diameter by 70-80% bounce back to 50-60% the PTA+Stent placement group was better significently than mere PTA group.we can find out that treatment effect in PTA+Stent placement group was more significant than the PTA group, especially in restenosis of iliac vein,the fade of swelling and varicose veins local recurrence. All patients were followed up for 1 to 34 months, an average of 12 months.Conclusion:NIVCS has nonspecific clinical performance, so they are easily missed diagnosised, some symptoms and signs,like lower extremity varicose veins, unidentified lower limb pain, recurrence of varicose veins, recurrent lower limb skin eczema and ulcer,the symptoms do not compatible with the signs lower extremity varicose veins.If it can’t be diagnosised and treated earlier,it can cause severe injury of femoral superficial vein valve and great saphenous varicose veins relapse after the operation,the iliac vein stenosis aggravated and it may forms DVT,fatal pulmonary embolism(PE), and post - thrombotic syndrome(PTS), then it may cases venous ulcers, venous claudication, repeated treat with the venous disease.the progress added both the physical、mental and economic burden.So early accurate diagnosis and treatment of NIVCS can reduce these risks.If we suspect in the iliac vein or abnormal pelvic blood flow signals during the conventional CDU examination,the consideration should be given to the possibility of NIVCS, adding anterograde venography can improve the diagnostic rate. Iliac vein venography is the gold standard in the diagnosis.Treatment should be strictly followed the indications, mere PTA recently has good curative effect, but there is still a possibility of iliac vein restenosis in the long term, PTA+Stent has good effect,At this present, the interventional therapy, which has the advantages of safe, minimally invasive and easy to operate. Strictly anticoagulation and regularly check are necessary to prevent the possibility of stent thrombosis.