Gong Maofeng, Jiang Rui, Kong Jie, Liu Zhengli, Zhao Boxiang, He Xu, Gu Jianping, Wu Zhengcan
Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Quant Imaging Med Surg. 2025 May 1;15(5):4193-4203. doi: 10.21037/qims-24-1831. Epub 2025 Apr 28.
Investigating the association between common iliac vein (CIV) compression and inferior vena cava (IVC) thrombosis could have important clinical implications, such as a potential reduction in the use of IVC filters in low-risk patients and guidance for decision-making in thrombosis management. This study aimed to clarify the impact of the CIV compression degree on the incidence of IVC thrombosis in patients with lower extremity deep vein thrombosis (DVT).
This single-center, retrospective study was performed between January 2015 and July 2023. A total of 391 eligible patients (mean age 60.42±16.67 years; 53.96% male) were included. The quantitative evaluation included the minimum diameter of the CIV, and the compression percentage was calculated on computed tomography venography. Univariable analysis and subsequent multivariable analysis, as well as propensity score matching (PSM), were used to analyze odds ratios (ORs) with 95% confidence intervals (CIs). The association between IVC thrombosis and CIV compression on a continuous scale was evaluated via restricted cubic splines (RCSs).
Iliofemoral DVT and a larger minimum diameter were associated with an increased risk of IVC thrombosis, whereas older age and a higher compression percentage were linked to a decreased risk. After adjustments for age, male sex, hypertension, and iliofemoral DVT via PSM, the statistically significant associations of CIV minimum diameter (adjusted OR =1.10, 95% CI: 1.02-1.18; P<0.01) with compression percentage (adjusted OR =0.99, 95% CI: 0.98-0.99; P<0.01) and IVC thrombosis remained. A reduced risk of IVC thrombosis was significantly associated with moderate compression (OR =0.36; 95% CI: 0.17-0.78; P=0.01) and severe compression (OR =0.14; 95% CI: 0.05-0.42; P<0.01). The RCS analysis revealed that a smaller minimum diameter or greater compression percentage was associated with a continuously decreasing IVC thrombosis risk when the minimum diameter was <5.04 mm or compression was >49.81%.
Compared with no or mild compression, moderate and severe CIV compression was associated with a reduced risk of IVC thrombosis. A higher CIV compression degree was consistently associated with a decreased IVC thrombosis risk when the minimum diameter was <5.04 mm or when the compression was >49.81%.
研究髂总静脉（CIV）受压与下腔静脉（IVC）血栓形成之间的关联可能具有重要的临床意义，例如可能减少低风险患者下腔静脉滤器的使用，并为血栓形成管理中的决策提供指导。本研究旨在阐明CIV受压程度对下肢深静脉血栓形成（DVT）患者IVC血栓形成发生率的影响。
本单中心回顾性研究于2015年1月至2023年7月进行。共纳入391例符合条件的患者（平均年龄60.42±16.67岁；男性占53.96%）。定量评估包括CIV的最小直径，并在计算机断层扫描静脉造影上计算受压百分比。采用单变量分析及随后的多变量分析，以及倾向评分匹配（PSM）来分析比值比（OR）及95%置信区间（CI）。通过受限立方样条（RCS）评估IVC血栓形成与CIV受压在连续尺度上的关联。
髂股静脉DVT和较大的最小直径与IVC血栓形成风险增加相关，而年龄较大和较高的受压百分比与风险降低相关。通过PSM对年龄、性别、高血压和髂股静脉DVT进行调整后，CIV最小直径（调整后OR =1.10，95%CI：1.02 - 1.18；P<0.01）、受压百分比（调整后OR =0.99，95%CI：0.98 - 0.99；P<0.01）与IVC血栓形成之间仍存在统计学显著关联。IVC血栓形成风险降低与中度受压（OR =0.36；95%CI：0.17 - 0.78；P =0.01）和重度受压（OR =0.14；95%CI：0.05 - 0.42；P<0.01）显著相关。RCS分析显示，当最小直径<5.04 mm或受压>49.81%时，较小的最小直径或较大的受压百分比与IVC血栓形成风险持续降低相关。
与无受压或轻度受压相比，中度和重度CIV受压与IVC血栓形成风险降低相关。当最小直径<5.04 mm或受压程度>49.81%时，较高的CIV受压程度始终与IVC血栓形成风险降低相关。
