From the Guidelines
Atrophic iliac veins should be managed with a focus on improving circulation and addressing underlying causes, with endovascular interventions like stenting considered for severe cases with significant symptoms or complications, as recommended by the most recent consensus statement from the VIVA Foundation, the American Venous Forum, and the American Vein and Lymphatic Society 1.
Key Considerations
- Atrophic iliac veins are characterized by extrinsic compression of the iliac vein, resulting in intrinsic venous luminal stenosis, vessel wall fibrosis, and intraluminal webs or spurs 1.
- Patient selection based on symptoms is crucial, as anatomic compression can occur in both symptomatic and asymptomatic patients 1.
- Venous duplex ultrasound, insufficiency examinations, and axial imaging are commonly used to assess for the presence of a nonthrombotic iliac vein lesion, while venography and intravascular ultrasound (IVUS) are the mainstays for endovascular assessment and planning before stent placement 1.
Management Options
- For patients with symptomatic atrophic iliac veins, a combination of anticoagulation therapy and graduated compression stockings may be recommended, along with physical activity to promote blood flow 1.
- Endovascular interventions like balloon angioplasty and stenting may be necessary to restore adequate blood flow in severe cases with significant symptoms or complications, with iliac vein stenting shown to improve quality of life and symptomatology in patients with iliac vein stenosis >50% 1.
Important Factors
- Early intervention is crucial to prevent progression of venous disease and associated complications, with regular follow-up with vascular specialists every 3-6 months important to monitor progress.
- The most recent consensus statement from the VIVA Foundation, the American Venous Forum, and the American Vein and Lymphatic Society provides guidance for providers treating patients with nonthrombotic iliac vein lesions, including patient selection, imaging for diagnosis, technical considerations for stent placement, postprocedure management, and future research/educational needs 1.
From the Research
Atrophic Iliac Veins
- Atrophic iliac veins can be a result of iliac vein compression syndrome (IVCS) 2, which is caused by the compression of the common iliac vein by the right common iliac artery.
- IVCS can lead to chronic deep venous insufficiency, and approximately 2% to 5% of patients with chronic deep venous insufficiency of the left leg may have IVCS 2.
- Iliac vein compression (IVC) can also be thrombotic or non-thrombotic, and patients may present with symptoms such as lower leg pain, heaviness, venous claudication, swelling, hyperpigmentation, and ulceration 3.
Diagnosis and Treatment
- Diagnosis of iliac vein compression can be made using intravascular ultrasound (IVUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) 3.
- Endovascular therapy with stenting is the main treatment strategy for iliac vein compression, and dedicated nitinol venous stents are currently under review for potential approval in the United States 3.
- Iliac vein stenting is a safe and effective alternative to traditional open surgery, with a patency rate of 90% to 100% for nonthrombotic disease and 74% to 89% for post-thrombotic disease at 3 to 5 years 4.
Management Options
- Compression therapy can be used to manage venous and lymphatic diseases, including iliac vein compression, and a wide range of compression levels can be effective 5.
- Low levels of compression (10-30 mmHg) can be effective in preventing edema and deep vein thrombosis, while high levels of compression (30-40 mmHg) can be effective in healing leg ulcers and preventing progression of post-thrombotic syndrome 5.