Abstract
Summary: Iliac vein compression syndrome, also known as May-Thurner Syndrome, is a type of vein reflux disorders which is often ignored due to lack of efficient diagnostic methods. The traditional gold standard of diagnosis is venography, but this has been challenged and largely replaced by intravascular ultrasound (IVUS). Here we report a case that a patient suffered with iodine anaphylaxis was successfully performed iliac vein stenting guided by using IVUS alone. This case provides the evidence that IVUS can offer necessary information for physicians in the diagnosis and treatment of iliac vein compression. We also find that balloon dilatation notch cannot precisely reflect the whole lesion, indicating it may be unreliable for diagnosis. Differ from the commonly accepted opinion, we find that comparing to IVUS, the notch of balloon dilatation cannot completely reflect the extent of lesion narrowness. Thus, we think the notch should not be used as a reference for seriousness of the lesion, and the diagnosis of stenosis cannot be ruled out even if there is no presence of notch.
References
1 . Best management options for chronic iliac vein stenosis and occlusion. J Vasc Surg. 2013;57(4):1163–9.
2 . Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 2002;35(4):694–700.
3 . May-Thurner syndrome: Update and review. Ann Vasc Surg. 2013;27(7):984–95.
4 . May-Thurner syndrome – Are we aware enough? Vasa. 2019;48(5):381–88.
5 . May-Thurner syndrome. Vasa. 2019;48(5):377–8.
6 Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord. 2017;5(5):678–87.
7 . CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Intervent Radiol. 2014;37(4):889–97.
8 . Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg. 2007;46(5):979–90.
9 . Importance of intravascular ultrasound imaging during percutaneous treatment of May-Thurner syndrome. J Vasc Surg. 2012;56(2):580–1.
10 Role of IVUS versus venograms in assessment of iliac-femoral vein stenosis. J Vasc Surg. 2010;52(3):804.
11 . Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39(5):937–43.
12 Analysis of threshold stenosis by multiplanar venogram and intravascular ultrasound examination for predicting clinical improvement after iliofemoral vein stenting in the VIDIO trial. J Vasc Surg Venous Lymphat Disord. 2018;6(1):48–56.
13 . Hemodynamics of “critical” venous stenosis and stent treatment. J Vascular Surg Venous Lymphat Disord. 2014;2(1):52–9.
14 . What is pathological May-Thurner syndrome? Phlebology. 2017;32(7):440–2.
15 . Optimal sizing of iliac vein stents. Phlebology. 2018;33(7):451–7.
16 . Percutaneous retrieval of a Wallstent from the pulmonary artery following stent migration from the iliac vein. J Interv Cardiol. 2002;15(2):101–6.
17 . VESS25. Inadequacies of venographic assessment of anatomic variables in iliocaval disease. J Vasc Surg. 2016;63(6):33S–34S.
18 . Anomalous features of iliac vein stenosis that affect diagnosis and treatment. J Vasc Surg Venous Lymphat Disord. 2014;2(3):260–7.
19 . Current status of carbon dioxide angiography. J Vasc Surg. 2017;66(2):618–37.