Diagnostics of Left Common Iliac Vein Compression Stenosis

Objective. To determine hemodynamic significance of the left common iliac vein compression (CIVC) considering clinical, ultrasound, and X-ray venographic data. Material and methods. A total of 110 symptomatic and asymptomatic patients with left-sided CIVC were included in a single-center crossover study. Doppler ultrasound was performed in all patients to determine maximum blood flow velocity (MFV) in poststenotic (MFVpoststenotic) and prestenotic (MFVprestenotic) segments, presence and duration of reflux in pelvic veins. CT venography was performed in all patients to evaluate narrowing and pancaking of the left CIV. Multiplanar pelvic venography was performed in 87 symptomatic patients to assess narrowing of the left CIV, width of pancaking and collateral blood flow through the pelvic veins. Results. Hemodynamically significant left-sided CIVC is always accompanied by symptoms of pelvic venous insufficiency (PVI). Any left-sided CIVC is insignificant a priori without PVI signs. Ultrasound criteria of significant CIVC included MFVpoststenotic/MFVprestenotic>2.5 and duration of pelvic venous reflux >2 seconds. CT sign of severe CIVC was CIV stenosis >50%. CT venography revealed no differences in signs of significant CIVC between symptomatic and asymptomatic patients. Multiplanar pelvic venography revealed hemodynamically significant CIVC in 56.3% of symptomatic patients. It was characterized by pancaking of the left CIV > 20 mm, width of the left CIV exceeding the right one by 30% or more and collateral blood flow in the pelvis without Valsalva maneuver. No correlation was found between severity of narrowing of the left CIV and significant left-sided CIVC. Concordance of Doppler ultrasound and multiplanar pelvic venography in identifying significant left-sided CIVC was 48.9%, CT venography and multiplanar pelvic venography — 59.2%. Conclusions. Stenosis of left CIV is not the main criterion for hemodynamic significance of left-sided CIVC and does not influence the symptoms of PVI. Clinical manifestations of left-sided CIVC are due to reflux in pelvic veins lasting >2 seconds. MPV is the most accurate method for analysis of hemodynamic significance of left-sided CIVC.