Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiology. Mar 28, 2020; 12(3): 18-28
Published online Mar 28, 2020. doi: 10.4329/wjr.v12.i3.18
Review of imaging and endovascular intervention of iliocaval venous compression syndrome
Ming Ren Toh, Tjun Yip Tang, Han Hui Mervin Nathan Lim, Nanda Venkatanarasimha, Karthikeyan Damodharan
Ming Ren Toh, Duke-NUS Medical School, Singapore 544886, Singapore
Tjun Yip Tang, Department of Vascular surgery, Singapore General Hospital, Singapore 169608, Singapore
Han Hui Mervin Nathan Lim, Yong Yoo Ling School of Medicine, Singapore 117597, Singapore
Nanda Venkatanarasimha, Department of Radiology, Singapore General Hospital, Singapore 169608, Singapore
Karthikeyan Damodharan, Department of Radiology, SengKang General Hospital, Singapore 544886, Singapore
Author contributions: Toh MR, Lim HHMN, Tang TY, Venkatanarasimha N and Damodharan K researched literature and conceived the study; Toh MR wrote the first draft of the manuscript; all authors reviewed and edited the manuscript and approved the final version of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Karthikeyan Damodharan, MBBS, Doctor, Department of Radiology, SengKang General Hospital, 10 Sengkang E Way, Singapore 544886, Singapore. karthikeyan.damodharan@singhealth.com.sg
Received: December 7, 2019
Peer-review started: December 7, 2019
First decision: December 25, 2019
Revised: January 4, 2020
Accepted: January 13, 2020
Article in press: January 13, 2020
Published online: March 28, 2020
Processing time: 81 Days and 10.5 Hours
Abstract

Iliocaval venous compression syndrome (ICS) is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra. Chronic compression can lead to venous stenosis and stasis, which manifests as chronic venous disease and treatment resistance. Therefore, early recognition of ICS and prompt treatment are essential. Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies. The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass, which is followed by computed tomography (CT) or magnetic resonance (MR) venography. CT and MRI can identify the anatomical causes for venous compression. In patients with high clinical suspicion for ICS, negative findings on CT and MR venography would still warrant further investigations. Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality. In this review paper, we will discuss the evidence, utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.

Keywords: Iliocaval venous compression syndrome, Duplex ultrasound, Intravascular ultrasound, Computed tomography venography, Magnetic resonance venography, Endovascular stent

Core tip: Imaging modalities are crucial to the diagnosis of iliocaval compressions. In this review, we will explore the various imaging modalities and their associated signs of iliocaval compressions, advantages/disadvantages, and sensitivity/specificity. We will also discuss their utility in the diagnosis and management of this condition. Main aim is to raise awareness among the general practitioners and specialists, facilitate the prompt diagnosis and treatment of patients with acute/chronic leg swelling secondary to iliocaval venous compressions.