Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency

• Main Authors: Fabio Henrique Rossi, Carlos Alexandre Rosa Gama, Igor Yoshio Imagawa Fonseca, Keilyanne Jaira Ferreira Barros, Thiago Osawa Rodrigues, Ibraim Masciarelli Francisco Pinto, João Alexandre Natividade, Nilo Mitsuru Izukawa
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) 2014-12-01
• Series: Jornal Vascular Brasileiro
• Subjects: veia ilíaca; tomografia; constrição patológica; ultrassonografia; Doppler
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492014000400306&lng=en&tlng=en

Objective:Iliocaval obstruction is associated with venous hypertension symptoms and may predispose to deep venous thrombosis (DVT). Ultrasonography may fail to achieve noninvasive diagnosis of these obstructions. The possibility of using Computed Tomography Venography (CTV) for these diagnoses is under investigation.Methods:Patients with CVI graded at CEAP clinical classes 3 to 6 and previous treatment failure underwent evaluation with CTV. Percentage obstruction was rated by two independent examiners. Obstruction prevalence and its associations with risk factors and CEAP classification were analyzed.Results:A total of 112 limbs were prospectively evaluated. Mean patient age was 55.8 years and 75.4% were women. Obstructions involved the left lower limb in 71.8% of cases and 35.8% of patients reported a medical history of deep venous thrombosis. Overall, 57.1% of imaging studies demonstrated venous obstruction of at least 50% and 10.7% showed obstruction of >80%. The only risk factor that was found to be independently associated with a significantly higher incidence of >50% venous obstruction was a medical history of DVT (p=0.035) (Fisher's exact test). There was a positive relationship between clinical classification (CEAP) and degree of venous obstruction in the limbs studied (Chi-square test for linear trend; p=0.011).Conclusion:Patients with advanced CVI are often affected by obstructions in the iliocaval venous territory and CTV is able to diagnose the degree of obstruction. There is a positive association between degree of obstruction and both previous history of DVT and severity of symptoms of CVI.