Effect Of 3D Rotation Venography For Evaluation Of Stenosis Of Iliac Vein

Background:Iliac vein compression syndrome (IVCS), also known as May-Thurner syndrome, is caused by the compression of the front right iliac artery and sacral promontory, it is an important cause of deep vein thrombosis (DVT).It can be expressed as varicose veins, leg edema, pigmentation, venous ulcers and other symptoms. Venous angiography is the gold diagnosis standard for the venous disease, due to the influence of local factors such as anatomy, simple two-dimensional digital subtraction angiography for the diagnosis of iliac vein stenosis shows lower rate, there is a need to explore further inspection methods in order to improve the diagnostic accordance rate.Purpose:To evaluate the three-dimensional rotational angiography (3D RV) and two-dimensional digital subtraction angiography (2D DSV) on the diagnostic value of iliac vein compression syndrome, in order to improve the diagnosis of IVCSMethod:A retrospective analysis were done among the patients treated for chronic lower extremity edema in Binzhou Medical university affiliated hospital from March 2012 to December 2013 period. Routine iliac vein 2D DSV, left common iliac vein 3D RV and iliac venous pressure in patients. When iliac vein with manometry pressure gradient greater than 2 mm Hg iliac vein stenosis as the gold standard for diagnosis. The results will be 2D DSV,3D RV angiography were with iliac vein manometry results for comparison, evaluate the diagnostic value of 2D DSV and 3D RV for iliac vein compression syndrome.Results:A total of 36 patients were selected, of which two cases found by angiography double inferior vena cava were excluded.34 cases of patients with chronic lower extremity edema, two-dimensional digital subtraction angiography angiography showed 20 cases of stenosis,14 cases angiography showed no stenosis,20 cases of angiographic stenosis iliac venous pressure gradient measurement results were more than 2mmHg (between 6-between 27mmHg, average 15.8mmHg). Two-dimensional digital subtraction angiography showed 14 cases of patients with significant stenosis in 10 patients with iliac venous pressure gradient measurement result is greater than 2mmHg (between 2-6mmHg, average 3.6mmHg), the other 4 patients iliac venous pressure gradient measurement result is less than 2mmHg. Three-dimensional rotational angiography revealed 28 patients with varying degrees of iliac vein stenosis, including 27 patients with iliac venous pressure gradient measurement result is greater than 2mmHg (2-27mmHg, an average of 12.7 mmHg). Three-dimensional rotational angiography six cases no significant iliac vein stenosis in 3 patients with iliac venous pressure gradient greater than 2mmHg. Three-dimensional rotational angiography diagnostic accuracy of iliac vein stenosis was 88.2% and the sensitivity was 90% two-dimensional digital subtraction angiography in the diagnosis of iliac vein stenosis accuracy rate of only 70.6%, sensitivity 66.7%, specificity 100%, positive predictiveConclusion:1.Two dimensional DSV image has high specificity for the diagnosis of left iliac veinstenosis, but the diagnosis sensitivity and diagnosis rate are all low.2.Three dimensional rotational angiography has high sensitivity and diagnosis rate for the diagnosis of left iliac veinstenosis, but the diagnosis specificity is low.3.On the basis of the two-dimensional digital subtraction angiography combined with three-dimensional rotational angiography iliac vein stenosis can improve the sensitivity and specificity of diagnosis.