Clinical research study
Venous laboratory
Correlation of venous symptoms with iliac vein stenosis on magnetic resonance imaging

Presented at the Thirty-second Annual Meeting of the Eastern Vascular Society, Washington, D.C., September 6-8, 2018.
https://doi.org/10.1016/j.jvsv.2020.12.077Get rights and content

Abstract

Objective

Magnetic resonance imaging (MRI) is used in patients with lower extremity venous disease to screen for iliac vein stenosis. The objective of the present study was to determine the prevalence of iliac vein stenosis and associated lower extremity venous symptoms in consecutive patients undergoing MRI of the pelvis.

Methods

A retrospective study of all consecutive adult patients who had undergone MRI of the pelvis for various indications from March 2012 to June 2016 was performed. The electronic medical records (EMRs) were reviewed for patient characteristics and, specifically, for the presence and laterality of venous symptoms. All MRI scans were reviewed, and the maximal degree of iliac vein stenosis was recorded. All the patients also responded to a brief telephone survey inquiring about the presence of venous symptoms. Two thresholds of venous stenosis, ≥50% and ≥70%, were used to correlate its presence with the presence of venous symptoms determined from the EMR review and telephone survey results.

Results

A total of 120 patients were included, with a mean age of 53 ± 14 years; 79% were women and 79% were white. The prevalence of iliac vein stenosis ≥50% was significantly greater on the left than on the right (34.2% vs 16.7%; P < .001). The survey demonstrated that 44 of the 120 patients (36.7%) had had venous symptoms compared with only 30 patients (25%) according to the EMR review (P = .001). No differences were found between patients with positive vs negative survey results for venous symptoms and the occurrence of iliac vein stenosis ≥50% on the right (17.2% vs 15.2%; P = .78) or the left (38% vs 26.8%; P = .22). We also found no differences when the occurrence of iliac vein stenosis ≥70% was used as threshold between the right (2.3% vs 3%; P = .99) and the left (10.1% vs 2.4%; P = .16). Analysis of the venous symptoms from the EMR review yielded similar results.

Conclusions

In our study, iliac vein stenosis was more common on the left and was encountered in up to one third of patients who had undergone MRI of the pelvis. No correlation was found in our study between the presence of iliac vein stenosis and the occurrence of ipsilateral venous symptoms. Venous symptoms were underreported in the EMRs. Further studies are necessary to identify the predictors of pathologic iliac vein stenosis.

Section snippets

Study population

A retrospective review of consecutive adult patients who had undergone MRI of the abdomen and/or pelvis at Yale New Haven Hospital for various indications from 2012 to 2016 was conducted. Patients aged ≤18 years and those with MRI showing positive oncologic findings in the abdomen and/or pelvis, metastatic cancer, or inferior vena cava atresia or congenital absence of the inferior vena cava were excluded. The institutional review board approved the present study and determined that only

Patient population

A total of 254 patients were identified who had undergone MRI of the abdomen and/or pelvis during the study period. Of the 254 patients, 134 were excluded from the present study because of an inability to conduct the telephone survey. Of these 134 patients, 12 had died, 21 had opted out, 9 did not speak English sufficiently, and 92 we could not reach by telephone. Thus, 120 patients were included in the present study. Their mean age was 53 ± 14 years. Of the 120 patients, most were women (79%)

Discussion

The present study has demonstrated the prevalence of iliac vein stenosis in consecutive patients who had undergone MRI of the pelvis for various indications at a single center. The prevalence of iliac vein stenosis of ≥50% was 41% on the left and 17% on the right. However, no correlation was found between the presence of venous symptoms and the degree of iliac vein stenosis using either the EMR findings or the telephone survey results. Approximately 32% of patients with venous disease were

Conclusions

In our study, iliac vein compression of ≥50% was more common on the left and was encountered in ≤40% of patients who had undergone MRI of the pelvis. We found that venous symptoms were underreported in the EMRs and that up to one third of patients with venous insufficiency might not have had that condition noted in the EMRs. We found no correlation in our study between the presence of iliac vein stenosis and the occurrence of ipsilateral venous symptoms. Therefore, iliac vein stenosis, per se,

Author contributions

Conception and design: AA, SH, RA, COC

Analysis and interpretation: AA, YD, AD, COC

Data collection: AA, NN

Writing the article: AA, COC

Critical revision of the article: AA, SH, YD, RA, NN, AD, COC

Final approval of the article: AA, SH, YD, RA, NN, AD, COC

Statistical analysis: SH

Obtained funding: Not applicable

Overall responsibility: COC

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Author conflict of interest: none.

Additional material for this article may be found online at www.jvsvenous.org.

The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

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