Diagnosis and endovascular treatment of iliocaval compression syndrome

Purpose: The purpose of this study was to evaluate the clinical presentatio n, diagnosis, and endovascular treatment of iliocaval compression syndrome (ICS). Patients and Methods: During a 3-year period, 18 patients (17 women, 1 man; mean age, 42 years) presented with clinical and imaging findings consisten t with ICS. All patients were evaluated with venography and Doppler ultraso und (DUS), 13 of 18 with intravascular pressure measurements, 12 of 18 with intravascular ultrasound, 9 of 18 with air plethysmography (APG), and 4 of 18 with magnetic resonance venography. Seventeen patients were treated wit h endovascular stenting, one was treated with angioplasty alone, and six re ceived adjunct thrombolysis. Results: Despite the presence of stenosis or occlusion in all cases, APG in dicated no iliac vein obstruction (outflow fraction greater than or equal t o 40%) in nine patients. DUS revealed acute (6) or chronic (7) unilateral i liofemoral deep venous thrombosis in 13 of 18 patients, whereas the results of five of 18 DUS studies were normal. Recanalization and stent placement (n = 17) or angioplasty (n = 1) was achieved in all patients. The average p ressure gradient was 5.6 mm Hg preprocedure and 0.6 mm Hg postprocedure. Th e primary patency rate demonstrated with DUS (n = 17) and venography (n = 7 ) at 6 months was 89%. The primary patency rate at 12 months was 79%. Conclusions: ICS often presents as sudden unilateral left lower extremity p ain and swelling in young to middle-aged female patients after pregnancy, s urgery, or a period of inactivity. Venography, intravascular ultrasound, an d magnetic resonance venography demonstrate high sensitivity, whereas APG-o utflow fraction demonstrates low sensitivity in the diagnosis of ICS. Endov ascular stenting and angioplasty provide safe and effective early and inter mediate-term treatment of symptomatic ICS.