Aurshina Afsha, Huber Steffen, Deng Yanhong, Attaran Robert, Nassiri Naiem, Dardik Alan, Ochoa Chaar Cassius Iyad
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
Department of Radiology, Yale University School of Medicine, New Haven, Conn.
J Vasc Surg Venous Lymphat Disord. 2021 Sep;9(5):1291-1296.e1. doi: 10.1016/j.jvsv.2020.12.077. Epub 2020 Dec 30.
Magnetic resonance imaging (MRI) is used in patients with lower extremity venous disease to screen for iliac vein stenosis. The objective of the present study was to determine the prevalence of iliac vein stenosis and associated lower extremity venous symptoms in consecutive patients undergoing MRI of the pelvis.
A retrospective study of all consecutive adult patients who had undergone MRI of the pelvis for various indications from March 2012 to June 2016 was performed. The electronic medical records (EMRs) were reviewed for patient characteristics and, specifically, for the presence and laterality of venous symptoms. All MRI scans were reviewed, and the maximal degree of iliac vein stenosis was recorded. All the patients also responded to a brief telephone survey inquiring about the presence of venous symptoms. Two thresholds of venous stenosis, ≥50% and ≥70%, were used to correlate its presence with the presence of venous symptoms determined from the EMR review and telephone survey results.
A total of 120 patients were included, with a mean age of 53 ± 14 years; 79% were women and 79% were white. The prevalence of iliac vein stenosis ≥50% was significantly greater on the left than on the right (34.2% vs 16.7%; P < .001). The survey demonstrated that 44 of the 120 patients (36.7%) had had venous symptoms compared with only 30 patients (25%) according to the EMR review (P = .001). No differences were found between patients with positive vs negative survey results for venous symptoms and the occurrence of iliac vein stenosis ≥50% on the right (17.2% vs 15.2%; P = .78) or the left (38% vs 26.8%; P = .22). We also found no differences when the occurrence of iliac vein stenosis ≥70% was used as threshold between the right (2.3% vs 3%; P = .99) and the left (10.1% vs 2.4%; P = .16). Analysis of the venous symptoms from the EMR review yielded similar results.
In our study, iliac vein stenosis was more common on the left and was encountered in up to one third of patients who had undergone MRI of the pelvis. No correlation was found in our study between the presence of iliac vein stenosis and the occurrence of ipsilateral venous symptoms. Venous symptoms were underreported in the EMRs. Further studies are necessary to identify the predictors of pathologic iliac vein stenosis.
磁共振成像（MRI）用于下肢静脉疾病患者以筛查髂静脉狭窄。本研究的目的是确定连续接受骨盆MRI检查的患者中髂静脉狭窄的患病率及相关的下肢静脉症状。
对2012年3月至2016年6月期间因各种适应证接受骨盆MRI检查的所有连续成年患者进行回顾性研究。查阅电子病历（EMR）以了解患者特征，特别是静脉症状的存在情况及部位。对所有MRI扫描进行评估，并记录髂静脉狭窄的最大程度。所有患者还接受了一次简短的电话调查，询问静脉症状的存在情况。采用两个静脉狭窄阈值，即≥50%和≥70%，将其存在情况与根据EMR回顾和电话调查结果确定的静脉症状的存在情况进行关联。
共纳入120例患者，平均年龄53±14岁；79%为女性，79%为白人。髂静脉狭窄≥50%的患病率左侧显著高于右侧（34.2%对16.7%；P<.001）。调查显示，120例患者中有44例（36.7%）有静脉症状，而根据EMR回顾仅有30例患者（25%）有静脉症状（P=.001）。静脉症状调查结果为阳性和阴性的患者之间，右侧（17.2%对15.2%；P=.78）或左侧（38%对26.8%；P=.22）髂静脉狭窄≥50%的发生率无差异。当以≥70%的髂静脉狭窄发生率为阈值时，右侧（2.3%对3%；P=.99）和左侧（10.1%对2.4%；P=.16）之间也未发现差异。对EMR回顾中的静脉症状分析得出了类似结果。
在我们的研究中，髂静脉狭窄在左侧更为常见，在接受骨盆MRI检查的患者中高达三分之一会出现。在我们的研究中，未发现髂静脉狭窄的存在与同侧静脉症状的发生之间存在关联。EMR中静脉症状的报告不足。有必要进行进一步研究以确定病理性髂静脉狭窄的预测因素。
