Predictors of pelvic venous compression on intravascular ultrasound from duplex ultrasound and venography

BackgroundPelvic venous compression syndromes (PVCS) are often underdiagnosed causes of chronic venous disease and deep vein thrombosis. This study evaluates whether duplex ultrasound and venography predict significant pelvic vein compression confirmed by intravascular ultrasound (IVUS).MethodRetrospective cohort of 237 adults with lower extremity symptoms undergoing duplex ultrasound including continuous spectral doppler waveform identification without volumetric flow, venography, and IVUS. Patients were classified by presence of ≥50% stenosis on IVUS. Logistic regression identified predictors.ResultReduced compressibility of the common femoral vein predicted ≥50% stenosis on venography bilaterally (left <i>p</i> = .025; right <i>p</i> = .014). The presence of thrombosis predicted ≥50% stenosis bilaterally (left <i>p</i> = .015; right <i>p</i> = .009), and abnormal spontaneity on the right also predicted ≥50% stenosis (<i>p</i> = .033). On duplex ultrasound, the absence of reflux (<i>p</i> = .008) and normal valvular competency (<i>p</i> = .008) on the left were associated with ≥50% stenosis on IVUS. Conversely, continuous phasicity (<i>p</i> = .036) and continuous flow (<i>p</i> = .035) on the left predicted <50% stenosis on IVUS.ConclusionCertain duplex ultrasound features may serve as early noninvasive markers of PVCS, aiding timely IVUS referral and intervention. Prospective studies are warranted.