Diagnosis and management of iliac vein compression syndrome

Iliac vein compression syndrome (IVCS) is the most probable cause of iliofemoral deep venous thrombosis (DVT). One half to two thirds of patients with left-sided iliofemoral DVT have intraluminal webs or spurs from chronic extrinsic compression of the left iliac vein at the crossing point of the right common iliac artery. Approximately 2% to 5% of those with chronic deep venous insufficiency of the left leg may have IVCS. IVCS occurs when compression of the common iliac vein is severe enough to inhibit the rate of venous outflow. In its more severe manifestation, IVCS is known to cause acute iliofemoral DVT. IVCS is caused by the combination of compression and the vibratory pressure of the right iliac artery on the iliac vein that is pinched between the artery and the pelvic bone. With the advent of catheter-directed thrombolytic therapy for patients presenting with iliofemoral DVT, the underlying cause has been unveiled and IVCS is gaining recognition. Patients presenting with symptoms of chronic venous insufficiency often fail conservative treatment, and because of their crippling symptoms, they may have a high rate of work absence or are on permanent disability. If IVCS can be identified as the cause and corrected, the patients' quality of life would improve. With the advent of endovascular stenting, the underlying cause can be easily corrected, and long-term patency is acceptable. Diagnosis can be made by being highly suspicious when patients present in either the acute or chronic state and selecting the best diagnostic tool to confirm the diagnosis. This article discusses the prevalence of IVCS, its significance for the affected population, and the relevance of recognition, and reviews the best methods of its diagnosis and treatment. Special emphasis is placed on diagnostic tools and their efficacy, and our results to date are reported.