Prevalence and predictors of radiological left common iliac vein compression in asymptomatic patients

Hai-Lei Li; Kristine J S Kwan; Yiu Che Chan; Wubulikasimu Wulamu; Stephen W Cheng

doi:10.1016/j.jvsv.2023.07.011

Prevalence and predictors of radiological left common iliac vein compression in asymptomatic patients

J Vasc Surg Venous Lymphat Disord. 2024 Jan;12(1):101661. doi: 10.1016/j.jvsv.2023.07.011. Epub 2023 Aug 10.

Authors

Hai-Lei Li¹, Kristine J S Kwan¹, Yiu Che Chan², Wubulikasimu Wulamu¹, Stephen W Cheng³

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, University of Hong Kong - Shenzhen Hospital, Shenzhen.
² Division of Vascular Surgery, Department of Surgery, University of Hong Kong - Shenzhen Hospital, Shenzhen; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong. Electronic address: ycchan88@hkucc.hku.hk.
³ Division of Vascular Surgery, Department of Surgery, University of Hong Kong - Shenzhen Hospital, Shenzhen; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.

PMID: 37572778
DOI: 10.1016/j.jvsv.2023.07.011

Abstract

Objective: The aim of this study was to investigate the prevalence of radiological left common iliac vein (LCIV) compression among the asymptomatic population and identify possible predictors.

Methods: Contrast-enhanced abdominal and/or pelvic computed tomography scans of eligible asymptomatic patients were examined. The LCIV diameter was measured from different horizontal planes in the venous phase using PACSView. Degree of LCIV compression (D_c) was calculated by a predefined formula and graded as insignificant (D_c < 25%), mild (≥25% D_c < 50%), moderate (≥50% D_c <75%), and severe (D_c ≥ 75%). Venous stenosis was defined as a D_c of ≥50%. Comparison of variables, including gender, age, body mass index (BMI), and comorbidities was performed between the different grades of LCIV compression.

Results: Between November 2019 and July 2022, 1698 eligible asymptomatic patients (53.1% females; mean age, 39.3 ± 11.8 years; mean BMI, 22.9 ± 3.6 kg/m²) were reviewed. The mean D_c was 46.2% (range, 0.29%-90.4%). Insignificant, mild, moderate, and severe compression were distributed in 14.5%, 38.0%, 42.2%, and 5.2% of the cohort population, respectively. Prevalence of venous stenosis was higher in females than males (58.1% vs 42.2%; χ² = 15.52; P < .001). Females aged ≥25 and <35 years accounted for the highest proportion of venous stenosis than other age groups and was a significant predictor (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.74-7.79; P < .001). In the Asian BMI classification group, being underweight is associated with venous stenosis (OR, 4.69; 95% CI, 2.70-8.14; P < .001) and obesity may be a protective factor (OR, 0.38; 95% CI, 0.23-0.64; P < .001). There is an inverse relationship between D_c and age and BMI.

Conclusions: The prevalence of radiological LCIV compression on computed tomography scans was high, but all patients were asymptomatic. Female gender, especially those aged ≥25 and <35 years, and underweight were possible predictors for venous stenosis.

Keywords: Chronic venous insufficiency; Left common iliac vein compression; May-Thurner syndrome; Radiology; Venous thromboembolism.

MeSH terms

Adult
Constriction, Pathologic / epidemiology
Female
Humans
Iliac Vein / diagnostic imaging
Male
May-Thurner Syndrome* / diagnostic imaging
May-Thurner Syndrome* / epidemiology
Middle Aged
Prevalence
Retrospective Studies
Thinness
Vascular Diseases*