Common iliac vein obstruction in a symptomatic population is associated with previous deep venous thrombosis, and with chronic pelvic pain in females.
OBJECTIVE
The objectives of this study were to determine the incidence of common iliac vein obstruction, gonadal vein incompetence, and renal vein compression/stenosis and to ascertain which referral reasons were associated with common iliac vein obstruction and gonadal vein incompetence in a population symptomatic for chronic venous insufficiency.


METHODS
Data were obtained from patients, at least 18 years old, who were referred to a private vascular laboratory for venous duplex ultrasound examination between 2016 and 2017. Transabdominal ultrasound was used to assess the iliac, gonadal, and renal veins in a dedicated protocol. Demographic data, referral reasons (varicose veins, lower limb pain, lower limb edema, lower limb ulcers, chronic pelvic pain [CPP]) and history of previous deep venous thrombosis (DVT) were recorded.


RESULTS
Among 421 patients (78.6% female; 57.7 ± 16.7 years), 46.7% had iliac vein obstruction, 40.1% had gonadal vein incompetence, and 29.9% had renal vein compression/stenosis. Venous disorders were significantly more prevalent among female patients and on the left side. The most common referral reasons were varicose veins for both sexes, followed by lower limb pain for females and lower limb edema for males, none of which were associated with any venous obstruction or incompetence. Previous DVT was significantly associated with common iliac vein obstruction for all patients (β = .189; P = .001), despite its being a previous known diagnosis for only 11.4% of patients. Among females, CPP was also significantly associated with common iliac vein obstruction and gonadal vein incompetence (β = .246 [P < .001] and β = .201 [P = .012], respectively). Among those with CPP in this study, common iliac vein obstruction, with and without gonadal vein incompetence (33% and 35%, respectively), was more prevalent than gonadal vein incompetence alone (14%).


CONCLUSIONS
History of DVT, as well as CPP among females warrants investigations of common iliac vein obstruction. Common iliac vein obstruction is likely to be a more significant contributor to CPP than gonadal vein incompetence.
['Larkin|Theresa A|TA|', 'Hovav|Oliver|O|', 'Dwight|Kate|K|', 'Villalba|Laurencia|L|']
D000328:Adult D000368:Aged D059350:Chronic Pain D003251:Constriction, Pathologic D005260:Female D006066:Gonads D006801:Humans D007084:Iliac Vein D015994:Incidence D008297:Male D062108:May-Thurner Syndrome D008875:Middle Aged D009517:New South Wales D017699:Pelvic Pain D015995:Prevalence D012082:Renal Veins D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D012737:Sex Factors D014689:Venous Insufficiency D020246:Venous Thrombosis
Deep venous thrombosis Venous obstruction Iliac vein compression May-Thurner syndrome Pelvic congestion syndrome