Iliac vein stenosis is an underdiagnosed cause of pelvic venous insufficiency

Santoshi, Ratnam K.N.; Lakhanpal, Sanjiv; Satwah, Vinay; Lakhanpal, Gaurav; Malone, Michael J.; Pappas, Peter J.

doi:10.1016/j.jvsv.2017.09.007

Cited by 55 publications

(38 citation statements)

References 30 publications

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“…1,2,15,16 We previously reported that in the current cohort, the average number of pregnancies in women with PVI was 3.36 AE 1.99. 3 This observation is similar to other previous reports. 1,4,17 The underlying mechanism of LE vein formation in women with documented PVI is unclear.…”

Section: Discussionsupporting

confidence: 93%

“…1,2 A recent publication by our group has indicated that the 80% of patients with PVI have an iliac vein obstruction with or without ovarian vein reflux. 3 Furthermore, the majority of these women presented with lower extremity (LE) pain, swelling and varicosities, before a diagnosis of PVI was entertained. It is well known that patients with PVI can present with LE varicosities that emanate from pelvic escape veins through the ovarian veins, internal iliacs, obturator, vulvar, internal pudendal and inferior gluteal veins.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and distribution of lower extremity reflux in patients with pelvic venous insufficiency

Scotti¹,

Pappas²,

Lakhanpal

et al. 2019

Phlebology

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Introduction Women with pelvic venous insufficiency often present with lower extremity symptoms and manifestations of chronic venous disorders. The purpose of this investigation was to determine the incidence of lower extremity chronic venous disorders and the types and distribution of lower extremity veins involved in patients with a known diagnosis of pelvic venous insufficiency. Methods Between January 2012 and December 2015, we retrospectively reviewed the charts of 227 women with pelvic venous insufficiency as well as their lower extremity venous duplex investigations. Presenting symptoms, Clinical, Etiology, Anatomy, Pathophysiology (CEAP) class, initial revised Venous Clinical Severity Score (rVCSS) and the types of lower extremity veins with reflux and their locations were noted. Patients were also subcategorized according to their primary pelvic disorder as follows: Entire cohort (PVI), Ovarian vein reflux (OVR), Iliac vein stenosis (IVS) or both (OVR + IVS). Results The study group consisted of 227 women (454 limbs) with documented pelvic venous insufficiency. The average age was 44.71 ± 10.2 years. In decreasing order, patients presented with the following lower extremity symptoms: pain (66%), swelling (32%), heaviness (26%), limb fatigue (13%), itching (13%), leg cramps (10%), skin changes or Superficial Venous Thrombosis (SVT) (2%) and ulceration or bleeding (0.08%). Table 1 outlines the CEAP class for 215 of the 227 patients. For the entire cohort, 48% of right and 50% of left limbs demonstrated C0 or C1 disease. The incidence and type of symptomatic lower extremity veins were as follows: any axial vein, 32%; great saphenous vein (GSV), 21%; small saphenous vein (SSV), 11%; GSV and SSV, 5%; non-saphenous tributaries, 15%; saphenous tributaries, 12%; posterior or postero-lateral thigh distribution, 5%; vulvar distribution, 4%; perforators, 4%; deep veins, 2%; and anterior accessory saphenous veins, 1%. For the GSV and SSV, the following patterns of reflux were observed: entire GSV, 4%; entire above knee GSV, 2%; entire below knee GSV, 2%; above knee segmental GSV, 20%; below knee segmental GSV, 21%; above and below knee GSV segmental disease, 1%; entire SSV, 4%; and SSV segmental disease, 12%. The incidence of reflux in any axial vein, the GSV and anterior accessory GSV was greater in the OVR group compared to IVS or OVR + IVS (p ≤ 0.03). In addition, 64 of 227 (28%) patients had a history of prior lower extremity venous ablations: OVR (10/39, 26%), IVS (15/50, 30%) and OVR + IVS (39/127, 9%). The number of ablations per patient was as follows—OVR: 1.48 ± 0.5, IVS: 1.7 ± 0.7 and OVR + IVS: 1.65 ± 0.7. Conclusion At least 50% of patients with pelvic venous insufficiency present with lower extremity venous disease. The incidence of reflux in any axial vein is greatest in the OVR group suggesting a correlation with hormonal fluctuations and pregnancy. The majority of symptomatic patients present with segmental axial GSV or SSV disease. Although vulvar and gluteal escape veins are highly associated with pelvic venous insufficiency, they are infrequently observed. In patients who experience residual or persistent symptoms after treatment for chronic venous disorders, a pelvic venous ultrasound should be performed to assess the presence of pelvic venous insufficiency.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Incidence and distribution of lower extremity reflux in patients with pelvic venous insufficiency

Scotti¹,

Pappas²,

Lakhanpal

et al. 2019

Phlebology

Self Cite

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“…There are also reports of some degree of iliac vein stenosis in up to 80% of patients with pelvic venous insufficiency. 13 The etiology of primary reflux has not yet been fully explained. It is estimated that it involves a genetic component in up to 50% of patients.…”

Section: Pathophysiologymentioning

confidence: 99%

Síndrome da congestão pélvica e embolização de varizes pélvicas

et al. 2019

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Resumo A síndrome da congestão pélvica (SCP) é definida como dor pélvica crônica há mais de 6 meses associada a varizes perineais ou vulvares, resultantes do refluxo ou obstrução das veias gonadais, glúteas ou periuterinas. A SCP é responsável por 16-31% dos casos de dor pélvica crônica, sendo diagnosticada sobretudo na terceira e quarta décadas de vida. Nos últimos anos, houve um interesse maior nessa patologia por parte dos cirurgiões vasculares devido à sua associação com insuficiência venosa de membros inferiores. Apesar de prevalente, a SCP ainda é pouco diagnosticada tanto nos consultórios ginecológicos quanto nos de angiologistas. Portanto, neste artigo revisaremos a etiologia e o diagnóstico desta patologia e os resultados dos diversos tipos de tratamentos disponíveis.

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“…which found that the rate was 1.5% over the short term for NIVLs. 4 Jayaraj et al. recently published updated data and found that the stent occlusion rate increased to ∼3% over long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Type of anti-thrombotic therapy for venous stenting in patients with non-thrombotic iliac vein lesions does not influence the development of in-stent restenosis

Tran

Lakhanpal

et al. 2020

Phlebology

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Background In patients receiving stents for symptomatic non-thrombotic iliac vein lesions, many clinicians prescribe anti-thrombotic medications. Whether or not anti-coagulation post-venous stenting improves stent patency is unknown. The aim of this investigation is to determine whether prophylactic post-operative anti-thrombotic therapy improves stent patency and/or prevents in-stent restenosis. Methods The medical records and venous ultrasounds for 389 patients stented for non-thrombotic iliac vein lesions were retrospectively reviewed. Patients were categorized into three anti-thrombotic regimens: Clopidogrel, Aspirin and Clopidogrel, and Apixaban or Rivaroxaban. Patients were routinely assessed for restenosis and stent patency at 6, 26, and 52 weeks and treated with anti-thrombotics for 90 days. Results Freedom from in-stent restenosis at 6, 26, and 52 weeks were Clopidogrel (91.50, 82.91, 80.95%), Aspirin and Clopidogrel (88.68, 80.03, 80.03%), and Apixaban or Rivaroxaban (91.03, 85.11, 83.18%). Primary patencies were Clopidogrel (98.77, 98.77, 98.10%), Aspirin and Clopidogrel (100, 95.74, 95.74%), and Apixaban or Rivaroxaban (98.70, 98.70, 96.71%). There were no statistically significant differences. Conclusions The type of post-operative anti-thrombotic therapy for non-thrombotic iliac vein lesions does not appear to improve stent patency or prevent the development of in-stent restenosis.

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Iliac vein stenosis is an underdiagnosed cause of pelvic venous insufficiency

Cited by 55 publications

References 30 publications

Incidence and distribution of lower extremity reflux in patients with pelvic venous insufficiency

Incidence and distribution of lower extremity reflux in patients with pelvic venous insufficiency

Síndrome da congestão pélvica e embolização de varizes pélvicas

Type of anti-thrombotic therapy for venous stenting in patients with non-thrombotic iliac vein lesions does not influence the development of in-stent restenosis

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