Diagnosis of chronic iliac venous obstruction

Abstract

Stenting has become the first line of treatment for symptomatic chronic iliofemoral venous obstruction in patients with quality-of-life-impairing clinical manifestations who have failed conservative therapy. Patient selection for such intervention is, however, dependent on clear identification of relevant clinical manifestations and subsequent testing to confirm the diagnosis. In this regard, the physician engaged in management of such patients needs to be well-aware of symptoms and signs of chronic iliofemoral venous obstruction, and instruments used to grade chronic venous insufficiency and determine quality of life, in addition to diagnostic tests available and their individual roles. This review serves to provide an overview of the diagnosis of chronic iliofemoral venous obstruction and patient selection for stenting.

Keywords: Iliac vein stenting; Iliofemoral venous obstruction; May Thurner syndrome; Non thrombotic iliac vein lesion; Post thrombotic syndrome.

Fig 1

Venous occlusion air plethysmography (APG) device including the air chamber (A), heel support (B), rapid cuff inflation system (C), control panel (D), calibration syringe (E), and output plot generation (F). Control panel (ACI Corp); Rapid cuff inflation system (D. E. Hokanson, Inc).

Fig 2

Algorithm for management of chronic iliofemoral venous obstruction (CIVO). CEAP, Clinical, Etiology, Anatomy and Pathophysiology; CIVIQ, Chronic Venous Insufficiency Questionnaire; PTS, post-thrombotic syndrome; QoL, quality of life; VCSS, Venous Clinical Severity Score; VEINES-QoL/Sym, Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms.