Cheng Long, Zhao Hui, Zhang Fu-Xian
Department of Vascular Surgery, Beijing Shijitan Hospital, Beijing 100038, China.
Chin Med J (Engl). 2017 Jun 5;130(11):1269-1275. doi: 10.4103/0366-6999.206341.
Iliac vein compression syndrome (IVCS) is an important cause of deep vein thrombosis, but the incidence of IVCS is still unclear. The purpose of this prospective study was to determine the incidence of IVCS in an asymptomatic patient population and to evaluate the risk factors in patients with and without IVCS.
From October 2011 to November 2012, a total of 500 patients (228 women and 272 men; mean age of 55.4 ± 14.7 years) with no vascular-related symptoms were enrolled in this study. Computed tomography was performed to evaluate all patients. The degree of venous compression was calculated as the diameter of the common iliac vein at the site of maximal compression divided by the mean diameter of the uncompressed proximal and caudal left common iliac vein (LCIV). We compared the stenosis rate of the common iliac vein in women and men according to age and followed up patients to evaluate outcomes.
The mean compression degree of the LCIV was 16% (4%, 36%); 37.8% of patients had a compression degree ≥25% and 9.8% had a compression degree ≥50%. There was a significant difference between men and women in the LCIV compression degree (9% [3%, 30%] vs. 24% [8%, 42%]; U = 4.66, P< 0.01). In addition, the LCIV compression degree among younger women (≤40 years) was significantly different compared with that in older women (>40 years) (42% [31%, 50%] vs. 19% [5%, 39%]; U = 5.14, P< 0.001). Follow-up was completed in 367 patients with a mean follow-up of 39.5 months (range, 6-56 months). The incidence of IVCS in the follow-up period was 1.6%. Stenosis rate and the diameter of the site of maximal compression correlated with the incidence of IVCS. Multivariable Cox regression analysis showed that the stenosis rate was an independent risk factor of IVCS (Wald χ2 = 8.84, hazard ratio = 1.13, P< 0.001).
The incidence of IVCS was low and correlated with the stenosis rate of iliac vein. Preventative therapy may be warranted for common iliac vein compression in patients at an increased risk of venous thromboembolism, especially patients with a higher iliac vein compression degree.
髂静脉受压综合征（IVCS）是深静脉血栓形成的重要原因，但IVCS的发病率仍不明确。这项前瞻性研究的目的是确定无症状患者群体中IVCS的发病率，并评估有无IVCS患者的危险因素。
2011年10月至2012年11月，共有500例无血管相关症状的患者（228例女性和272例男性；平均年龄55.4±14.7岁）纳入本研究。对所有患者进行计算机断层扫描。静脉受压程度计算为最大受压部位的髂总静脉直径除以未受压的近端和远端左髂总静脉（LCIV）的平均直径。我们根据年龄比较了女性和男性髂总静脉的狭窄率，并对患者进行随访以评估结果。
LCIV的平均受压程度为16%（4%，36%）；37.8%的患者受压程度≥25%，9.8%的患者受压程度≥50%。LCIV受压程度在男性和女性之间存在显著差异（9%[3%，30%]对24%[8%，42%]；U = 4.66，P<0.01）。此外，年轻女性（≤40岁）的LCIV受压程度与老年女性（>40岁）相比有显著差异（42%[31%，50%]对19%[5%，39%]；U = 5.14，P<0.001）。367例患者完成随访，平均随访39.5个月（范围6 - 56个月）。随访期间IVCS的发病率为1.6%。狭窄率和最大受压部位的直径与IVCS的发病率相关。多变量Cox回归分析显示狭窄率是IVCS的独立危险因素（Wald χ2 = 8.84，风险比 = 1.13，P<0.001）。
IVCS的发病率较低，且与髂静脉狭窄率相关。对于静脉血栓栓塞风险增加的患者，尤其是髂静脉受压程度较高的患者，可能有必要进行预防性治疗。
