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Title: Prevalence, risk factors, and evaluation of iliocaval obstruction in advanced chronic venous insufficiency
Authors: Nuttawut Sermsathanasawadi
Kanin Pruekprasert
Wacharaphong Pitaksantayothin
Khamin Chinsakchai
Chumpol Wongwanit
Chanean Ruangsetakit
Pramook Mutirangura
Faculty of Medicine, Siriraj Hospital, Mahidol University
Keywords: Medicine
Issue Date: 1-May-2019
Citation: Journal of Vascular Surgery: Venous and Lymphatic Disorders. Vol.7, No.3 (2019), 441-447
Abstract: © 2018 Society for Vascular Surgery Objective: The aim of this study was to investigate the prevalence and clinical predictors of >50% iliocaval venous obstruction (ICVO) in Thai patients with lipodermatosclerosis and healed or active venous ulcers and the diagnostic accuracy of duplex ultrasound (DUS) compared with computed tomography venography (CTV). Methods: Limbs with lipodermatosclerosis, healed venous leg ulceration, or active venous leg ulceration were prospectively evaluated by DUS and CTV. Loss of respiratory variation in the common femoral vein (CFV) and reversed flow in the superficial epigastric vein (SEV) were evaluated by DUS. Percentage of venous obstruction was measured by CTV. The prevalence and clinical predictors of >50% ICVO were determined, and the accuracy of DUS for diagnosis of >50% ICVO was compared with the diagnostic accuracy of CTV. Results: A total of 106 patients (135 limbs) were enrolled. The mean age was 58 ± 12 years, and 57 (54%) patients were female. Previous history of deep venous thrombosis (DVT) in the symptomatic leg was documented in 21 (15.6%) limbs; >50% ICVO by CTV was found in 38 (28.1%) limbs. Independent predictors of >50% ICVO included left leg (P =.001) and previous history of DVT in the affected leg (P =.001). For diagnosis of >50% ICVO, the sensitivity and specificity of loss of respiratory variation in the CFV were 23.7% and 100%, respectively; the sensitivity and specificity of reversed flow in the SEV were 7.9% and 100%, respectively. Conclusions: Limbs with lipodermatosclerosis or with healed or active venous ulceration, especially in the left limb or in limbs with a history of DVT in the affected limb, had a high prevalence of ICVO; these limbs should be routinely studied with DUS. Limbs with an abnormal finding on DUS, including loss of respiratory variation in the CFV or reversed flow in the SEV, should be routed for venous intervention, and those with normal DUS findings should be referred for CTV.
ISSN: 22133348
Appears in Collections:Scopus 2019

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