The Incidence and Significance of Iliac Vein Stenosis in Patients with Deep Vein Thrombosis

Sahar Ali; Shin Mei Chan; Anand Brahmandam; Yunshan Xu; Yanhong Deng; Ahmed Elbadawy; Alfred Lee; Cassius Iyad Ochoa Chaar

doi:10.1016/j.avsg.2024.11.016

The Incidence and Significance of Iliac Vein Stenosis in Patients with Deep Vein Thrombosis

Ann Vasc Surg. 2024 Nov 29:111:310-318. doi: 10.1016/j.avsg.2024.11.016. Online ahead of print.

Authors

Sahar Ali¹, Shin Mei Chan², Anand Brahmandam³, Yunshan Xu⁴, Yanhong Deng⁴, Ahmed Elbadawy⁵, Alfred Lee⁶, Cassius Iyad Ochoa Chaar⁷

Affiliations

¹ Division of Vascular Surgery, Faculty of Medicine, Assiut University, Egypt. Electronic address: saharhamdi@aun.edu.eg.
² Integrated Interventional Radiology Department, University of California, San Francisco, USA.
³ Division of Vascular Surgery, Northwestern University, Chicago, IL, USA.
⁴ Yale School of Public Health, New Haven, CT, USA.
⁵ Division of Vascular Surgery, Faculty of Medicine, Assiut University, Egypt.
⁶ Section of Hematology, Yale University School of Medicine, New Haven, CT, USA.
⁷ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.

PMID: 39617297
DOI: 10.1016/j.avsg.2024.11.016

Abstract

Background: The role of iliac vein stenosis (IVS) in the development of deep vein thrombosis (DVT) is poorly understood. This study determines the incidence of IVS in patients diagnosed with DVT and assesses its impact on presentation and outcomes. Our hypothesis is that the presence of IVS increases the risk of long-term ipsilateral DVT recurrence.

Methods: A retrospective study of the electronic medical records of consecutive adult patients treated for lower extremity DVT was performed. Only patients with cross-sectional imaging (computed tomography or magnetic resonance with intravenous contrast) were included. Patient and DVT characteristics were recorded. Cross-sectional imaging was reviewed for the presence or absence of ipsilateral IVS (≥50%). Patients were divided into 2 groups based on the presence or absence of IVS to compare characteristics and outcomes. Subgroup analyses on patients with provoked DVT, cancer-related DVT, and unprovoked DVT were performed.

Results: There were 548 patients with DVT and 32% had evidence of ipsilateral IVS on cross-sectional imaging. There were no significant differences in baseline characteristics or treatment methods between the 2 groups. There was a trend toward patients with IVS having less incidence of pulmonary embolism on presentation (22.9% vs. 29.7%, P = 0.1) but that difference did not reach statistical significance in the overall comparison. Subgroup analysis in patients with cancer-related DVT (n = 227) showed that patients with IVS were significantly more likely to develop ipsilateral recurrent DVT compared to patients with no IVS (12.9% vs. 4.5%, P = 0.045). Patients with unprovoked DVT with IVS had significantly lower pulmonary embolism on presentation than patients with unprovoked DVT without IVS (24.2% vs. 39.8%, P < 0.03).

Conclusions: Ipsilateral ≥50% IVS is present in approximately a third of patients presenting with DVT. The presence of IVS seems to play a differential role in ipsilateral DVT recurrence and prevention of pulmonary embolization in different groups of patients presenting with DVT.