Clinical study
Common Iliac Vein Stenosis and Risk of Symptomatic Pulmonary Embolism: An Inverse Correlation

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Abstract

Purpose

To test the hypothesis that a common iliac vein (CIV) stenosis may impair embolization of a large deep venous thrombosis (DVT) to the lungs, decreasing the incidence of a symptomatic pulmonary embolism (PE).

Materials and Methods

Between January 2002 and August 2007, 75 patients diagnosed with unilateral DVT were included in a single-institution case-control study. Minimum CIV diameters were measured 1 cm below the inferior vena cava (IVC) bifurcation on computed tomography (CT) images. A significant stenosis in the CIV ipsilateral to the DVT was defined as having either a diameter 4 mm or less or a greater than 70% reduction in lumen diameter. A symptomatic PE was defined as having symptoms and imaging findings consistent with a PE. The odds of symptomatic PE versus CIV stenosis were assessed using logistic regression models. The associations between thrombus location, stenosis, and symptomatic PE were assessed using a stratified analysis.

Results

Of 75 subjects, 49 (65%) presented with symptomatic PE. There were 17 (23%) subjects with a venous lumen 4 mm or less and 12 (16%) subjects with a greater than 70% stenosis. CIV stenosis of 4 mm or less resulted in a decreased odds of a symptomatic PE compared with a lumen greater than 4 mm (odds ratio [OR] 0.17, P = .011), whereas a greater than 70% stenosis increased the odds of DVT involving the CIV (OR 7.1, P = .047).

Conclusions

Among patients with unilateral DVT, those with an ipsilateral CIV lumen of 4 mm or less have an 83% lower risk of developing symptomatic PE compared with patients with a CIV lumen greater than 4 mm.

Section snippets

Study Design

A retrospective case-control study was conducted at a single tertiary care academic center under institutional review board approval. An International Classification of Diseases, 9th Edition (ICD-9) code search was performed to identify all new diagnoses of DVT (451.x and 453.x) from January 2002 to August 2007 among all patients older than 18 years. The search identified 726 patients. Inclusion into our study required computed tomography (CT) imaging to allow vessel measurement, so a Current

Results

Among 75 patients, 49 (65%) cases of symptomatic PE were found (Table 1). Of the 26 (35%) controls without symptomatic PE, 4 subjects exhibited clinical symptoms of tachycardia or hypoxia that were due to cardiac or infectious etiologies and did not have PE on CT angiography. The control and case populations were similar in mean age (58.3 y vs 59.0 y), proportion of women (53.8% vs 55.1%), and proportion of left-sided DVT (65.4% vs 65.3%). Overall, the left CIV was found to have a stenosis of

Discussion

Many biologic factors have been identified as important in the thrombogenesis of DVT, but risk stratification to predict the likelihood of PE has not been well documented among patients with VTE. Although CIV compression has been associated with an increased incidence of DVT, the true risk of developing clinically significant PE from this underlying condition is uncertain. Paradoxically, after the thrombus has formed, this anatomic condition can be beneficial in reducing the risk of a

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    Citation Excerpt :

    These differences likely arise from the different practice settings of the 2 studies (a dedicated outpatient venous center in the study by Tran et al (13) vs a quaternary care center in the present study) as well as different thresholds for stent placement. Tran et al (13) used a >50% stenosis cutoff for venous stent placement, whereas in the present study, a >70% cutoff was used, which has been shown to correlate with increased risk of symptomatic compression in prior studies (5,6,8,21). There were also large differences in the rate of in-stent restenosis between the present study and the study by Tran et al (13).

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From the SIR 2009 Annual Meeting.

None of the authors have identified a conflict of interest.

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