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New Vein Compression Entities in Patients with Unexplained Leg Swelling
Alaina Garrie1, Lauren E Jones2, Julia F Chen3
1Lehigh Valley Hospital, Allentown, PA.
Annals of Vascular Surgery
|June 26, 2017
Summary
This study highlights previously underreported sites of nonthrombotic venous outflow obstruction (NTVO) causing leg pain and swelling. Identifying these venous compression syndromes improves patient outcomes with targeted treatment.
Area of Science:
- Vascular Medicine
- Interventional Radiology
- Anatomy
Background:
- Unexplained lower extremity edema and pain can stem from nonthrombotic venous outflow obstruction (NTVO).
- Traditional imaging like ultrasound, CTA, and MRI may miss these obstructions.
- This study aimed to identify overlooked anatomical sites of NTVO.
Purpose of the Study:
- To identify and characterize underreported anatomical locations of nonthrombotic venous outflow obstruction.
- To evaluate the efficacy of angioplasty and/or stenting for these venous compressions.
- To propose a diagnostic approach for patients with unexplained leg symptoms.
Main Methods:
- Retrospective review of 75 patients with unexplained leg edema and pain undergoing venography.
- Categorization of venograms for NTVO lesions at specific anatomical sites.
- Intervention with angioplasty and/or stenting for >50% stenosis, followed by outcome documentation.
Main Results:
- 23 of 75 patients (30.7%) had NTVO, with 14 at previously underreported sites (inguinal ligament, iliac artery bifurcation, popliteal fossa).
- May-Thurner syndrome was identified in 9 patients.
- 64.3% of patients with NTVO at new sites reported significant pain and edema resolution after intervention.
Conclusions:
- Venous compression syndromes occur at additional sites beyond those typically recognized.
- Increased incidence of NTVO is suggested in patients with unexplained leg edema and pain.
- A diagnostic algorithm is proposed to aid in identifying NTVO using venography when initial imaging is inconclusive.
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